Exam 3 Flashcards by Chelsea curry

antacids

prevention of gastric ulcers

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H2 inhibitor (blocks parietal cell histamine receptors) that has slight interference with P450
Prevention of gastric ulcers
Also inhibits AchE

Ranitidine

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H2 inhibitorsblocks parietal cell histamine receptors) that prevent gastric ulcers, no interference with P450

Famotidine

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The 3 H:K ATPase inhibitors that prevent gastric ulceration

MOST effective when given prior to meal

Omeprazole

Iansoprazole (IV)

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Mucosal coating and completing agents that prevents gastric ulceration
Prodrug
And antiacid
no specific MOA (split sucrose and AI in acidic environemnt)

Sucralfate

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Prokinetic that prevents gastric ulceration, used in steroid or stressed pt

Cisapride

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Dopamine 2 agonist that induces emesis in CRTZ (DOGS)

very effective in dogs NOT cats

apomorphine

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Two alpha 2 agonists that induce emesis in CRTZ and vomiting center
Very effective in cats

xylazine and dexmedetomidine

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H1 inhibitor that is an antiemetic used for motion sickness Do not use in cats

Acts in CRTZ and M1 in vestibular system

diphenylhydramine

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Non specific antimuscarinic that is a weak antiemetic
Blocks prokinetics
Not recommended to use
vestibular (motion sickness) and CRTZ
effective but paralyzes the gut and reduced motility

Centrine

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Alpha 2 antagonist that are antiemetics (3)

act on voming center and CRTZ

chlorpromazine
Prochlorperazine
Ace (used for motion sickness too)

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Antiemetic

Act on vomiting center and CRTZ

approved for motion sickness, but may have broader use as antiemetic

Marcopitant

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Antiemetic
Dopamine and 5HT3 antagonist that is used in azotemia cases
Crosses BB and can cause tremors

acts in CRTZ
Not used in cats

Metoclopramide

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Serotonin antagonist (5HT3) antiemetic
acts in CRTZ and gut (not prokinetic)
effective in cats (better than metoclopramide)

Odansteron

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Mixed 5HT3 antagonist/5HT4 agonist prokinetic +Ach release
More potent, no antiemetic action
Used in steroid and stressed cases
Prevents gastric ulceration too

Cisapride

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Motilin agonist for ileusprokinetic 
Mixing contractions (post meal)
housekeeping contractions (independent of meals) sweep the length of the GIT

erythromycin

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Anticholinesterase prokinetic

also anti-ulcer drug

Ranitidine

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Morphine agonist that does not cross CNS
Antidiarrheal
Acts like a cork (increases mixing byt not propulsive contractions)

Loperamide

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Morphine agonist that does cross CNS, still weak
Antidiarrheal
inhibits secretion

Diphenoxylate

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Inhibitors of small intestinal secretion (PG and cAMP inhibitor)
Antidiarrheal
Antiinflammatory too

Bismuth subsalicylate

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antidiarrheal absorbent

Activated charcoal

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rounds, hooks

pyrantel

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tapes

Praziquantel

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rounds, whips, hooks

Milbemycin

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coccidiostats

Ponazuril

Cell wall inhibitors

penicillin cephalosporin vancomycin

Cell membrane leakage

polymycin

Affect nucleic acid metabolism

Rifamipin | enrofloxacin

Ab that inhibits RNA polymerase, horses

Rifamipin

Inhibition of protein synthesis (30 and 50S)

chloramphenicol Tetracycline Clindamycin

Inhibit protein synthesis (30S)

aminoglycosides

Ab that are Antimetabolites

trimethoprim, sulfonamides

Concentration dependent antibiotics where the goal is to maximize the concentration AUC24/MIC and Cmax/MIC

Quinolones Aminoglycosides Metronidazole

Time dependent antibiotics that have no persistent effects where the goal is maximize duration T>MIC

Beta lactam

Time dependent with persistent effects--> AUC24/MIC

Macrolides Tetracyclines Lincosamides

``` Time dependent Bacteriocidal Spectrum: gram +>gram - at higher doses Renal excretion, not highly protein bound does not cross normal BBB Most PO and distribute in body H2O ```

Beta lactams

3 ways bacteria become resistant to beta lactams

production of beta-lactamase changes in the structure of PBPs (MRSA) Impenetrable membrane pores

Use for UTIs Beta lactam tox: hypersensitivity

Penicillins

Natural penicillin

Penicillin G

amoxicillin, ampicillin

aminopenicillins

tarcarcillin

extended penicillin, effective against pseudomonas

clavulanic acid

penicillin that is a beta-lactamase inhibiotrs

First generation cephalosporins | 1st line of defense in SA

cephalexin

Cefadr | Limited use due to C and S findings

orsecond generation

ceftiofur | more gram negative function

3rd generation cephalosporin

Cefeprime | has beta-lactamase resistance

4th generation cepalosporin

Beta lactam Gram +, but can be gram - toxicity: hypersensitivity, GI, chronic use can cause overgrowth of certain organisms, immune reactions, drug fevers

cephalosporin

Expensive Beta lactam anaerobes, gram + Used in highly resistant cases

Carbepenems: imipenem

Concentration dependent bacteriocidal irreversible inhibition of 30S Spectrum: aerobic gram - (predominately bacilli), few gram +, ineffective against anaerobes Commonly used for UTIs with something else Renal elimation Resistance via: decreased membrane transport, altered ribosomal binding site Toxicity: nephro, oto, neuro, anaphylaxis Transport tetracyclines Do not use in pregnant/nursing, renal dz, fever and dehydration, MG, NM disorders

Aminoglycosides: Gentamycin and amikacin

Bacteriostatic Reversible inhibition of 30S Spectrum: gram +, gram - anaerobes, mycoplasmas, spirochetes, rickettsial, chlamydia Resistance via exclusion Mostly renally eliminated Tox: nephro, GI, hepatotoxic, phototoxic, dental/bone (juv), CV effects

Tetracyclines

large animal tetracycline that can cause diarrhea and shock in horses (arrhythmia)

Oxytetracycline

Crosses BBB/CSF More hepatic elimination (rather than renal) Tetracycline Do NOT dry pill cats

Doxycycline

Reversible inhibition of ribosomal protein synthesis 50S Bacteriostatic (can be cidal at high doses) Does not cross BBB Spectum: gram +, few gram-, and intracellular organisms Mixed elimination: renal, hepatic, biliary Tox: GI, extreme caution in horses (fatal colitis and diarrhea), some can make Clostridium sporulate

Macrolides: azithromycin and tylosin

Macrolides used for respiratory infections

Azithromycin

Interferes with folic acid synthesis necessary for purine synthesis Bacteriostatic (high levels it is cidal) Spectrum: gram +, gram - Tox: immune reactions (KCS), nephrotoxic, hemolytic/depression anemia

Sulfonamides | Sulfamethoxazole/triprim is cidal

Inhibits bacterial DNA gyrase (aka topisomerase II), blocks bacterial DNA transcription Bacteriocidal Concentration dependent Spectum: gram - and aerobes, not for most strep Mixed hepatic and renal elimination Tox: cartilage damage Contraindications: young, preg, cats, NSAIDS

Fluoroquinolones: enrofloxacin,marbofloxacin

antiprozoal (Giardia, trich) Cross BBB Concentration dependent MOA: unknown

Metronidazole

Bacteriostatic Prevent protein synthesis (50S) Anaerobes, strep, staph Oropharyngeal infections, resp, sepsis, bone infections

Lincosamides: Clindamycin

cell wall target gram + Misc polypeptide Ab

Bacitracin

last resort for MRSA Renal excretion Polypeptide Ab

Vancomycin

Polypeptide Ab | gram -

polymixins

Ab that cross the BBB

chloramphenicol Doxycycline Metro some cephalosporin (3rd generation) and in case of menigitis

``` cross BBB Bacteriostatic Reversible inhibition of protein synthesis (50S) Hepatitc metabolism Tox rare Do NOT use in food animals resistance via transmitted plasmid ```

phenicols, specifically chloramphenicol

Occur during phase 2 or 3 due to long AP, slow HR, low K Could be due to drugs, toxins, hypoxia, acidosis Beta agonist/vagolytics, Ca blockers, increase K, Mg to fix

EAD

Occur during phase 4 due to transient Ca or overload due to digoxin, hypoxia, catecholamines Targets to fix: beta blockers to increase AP duration, Ca channel blockers, decrease phase 0 via Na blockers

DAD

Occurs due to stretch, ischemia, electrolytes | to fix: decrease conduction->Na and Ca blockers; ^ refractoriness->K blockers

Re-entry

Decrease phase 0 Ventricular arrythmias Na channel blockers

Class I antiarrythmias

For normal and abnormal tissue | Prolong AP via phase 3, increase QT->risk for EAD

Class IA antiarrythmias

``` used for a fib in horses vagolytic: ^HR alpha antagonist: vasodilation - ionotrope do not use in bradyarr and CHF Compete with digoxin and decreases its excretion Class 1A antiarrythmia ```

Quinidine

second choice for v tach fewer autonomic effects and less ionotrope Do not use in bradyarrythmias and CHF Class IA antiarrythmic agent

Procainamide

Used in diseased or ischemic tissue | lidocaine and mexiletine

Class IB antiarrythmics

first choice for v tach no effect on atrial tissue Contraindication: bradyarrythmia Tox: CNS depression, nausea

lidocaine, class IB

Class IB antiarrythmic | usually used with beta blockers

Mexiletine"oral lidocaine"

Na channel blockers with no effect on repolarization

Class IC

Commonly used for SV arrythmias decrease SA node firing rate->vHR-> ^ perfusion v AV conduction->useful for SVTs and Afib - ionotrope-> v O2 consumption Can use in HCM and CHF wit active HF is resolved

Class II beta blocker antiarrythmics

Propanolol, sotalol | Non selective beta inhibition

first generation

atenolol, esmolol | Beta 1 selective antagonist

second generation

``` first generation->nonselective cross BBB uses: hyperthyroidism and pheochromocytomas decrease HR more than others caution: diabetes and resp dz ```

Propanolol

second generation-> B1 selective | Water soluble, renal excretion (unchanged)

atenolol

second generation->B1 selective very short acting Use: emergency tx of SVTs or dx

esmolol

first generation->non selective Also Class III antiarrythmic agent supra and ventricular arrythmias (e.g. ARVC in bocers, DAD, re-entry) Caution in CHF and QT prolongation->proarrythmic

Sotalol

Causes slow repolarization and prolonged AP duration More for ventricular arrythmias Side effect: predeposition to EADs and others that are drug specific

Class III antiarrythmics: K channel blockers

``` class 1,2,3,4, and alpha 1 blocker can cause pulmonary fibrosis, hypo/hyperthyroidsm, hepatotoxicity, GI, skin discoloration, neuro, corneal depositions, rxn to IV ```

Amiodarone

Slows SA/AV discharge therefore more for supraventricular arrhythmia Side effects: Myocardial and vascular smooth m (-ionotrope, vasodilation, hypotension, caution CHF), bradycardia/AV block

Class IV: Ca channel blockers

Class IV antiarrythmic ++ AV effects, ++ negative ionotrope, + vascular can cause nausea, depression, anorexia

Diltiazem

- AV nodal effects - negative ionotrope +++ vascular vasodilation... decreases afterload Class IV antiarrythmic

Amlodipine

Loop diuretic ^h20, Na, K, Cl, Ca, Mg excretion used in acute pulmonary edema and CHF Increases renin secretion therefore use always an ACE inhibitor

Furosemide

Loop diuretic used for diuretic resistance

Torsemide

Distal convoluted tubule ^H20, Na, Cl, K excretion dependent on GFR and delivery of Na

Hydrochlorothiazide

Potassium sparing diuretic distal tubue/CD Aldosterone antagonist

spironolaction

when veins dilate it...

decreases preload

When arterioles dilate...

decrease afterload

really no effect but still used in acute clinical CHF | nitrate vasodilator

Nitroglycerin

converted to NO tx of CHF due to MR and DCM risk of cyanide poisoning Nitrate venodilator

Nitroprusside

Increase cGMP Not used until CHF is refractory to other tx decreases afterload via arteriodilation

Hydralazine

used for pulmonary hypertension selective phosphodiesterase 5 inhibitor decreases PA pressure-> increase CO

Sidenafil

prodrug renal excretion ace inhibitor

enalapril

prodrug renal and hepatitc excretion ACE inhibitor

Benzazepril

Costs of inotropes

increased O2 consumption Myocardial ischemia-> myocyte death generation of malignant arrythmias

cardiac glycoside inhibits NA/ATPase pump-> ^ IC Na-> exchange for Ca-> ^ IC Ca-> ^ contractility also delays conduction and HR Used in severe valvular dz and DCM careful in dosing fat dogs and if ascites careful in renal dz cardiotoxic, GI and CNS, HYPOKALEMIA (compete with K for same site)

digoxin

Release adrenylate cyclase->cAMP->protein kinase->Ca influx low doses work on DA receptors to cause vasodilation (primarily renal) High doses-> B1-> + ionotropy even higher doses->alpha->vasoconstriction

Dopamine

B1 agonist with no real change in BP since both beta 2 and alpha receptor stimulated

Dobutamine, synthetic dopamine

Ca sensitizing agent increase affinity of troponin C for Ca during diastole and systole Also has phosphodiesterase III activity->systemic and pulmonary vasodilation=inodilator

Pimobeden

Properties determining how inhalants travel around the body

solubility | Blood:gas partition coefficient

Vapors max delivery concentration depends on...

saturated VP

determines how many molecules of inhalant are available to produce anesthesia

capor pressure

determines the max concentration of inhalant that can be delivered

saturated vapor pressure

temp down..saturated vapor pressure does what

goes down, less concentrated

Boiling point does what when altitude goes up

goes down

Name inhaled anesthetics in increasing boiling temperature

DES

What determines speed of onset and recovery from anesthesia

Solubility

determines the % of inhalants vs. alveoli when PP betw. between compartments

Solubility

if the B:G coefficient low means...

rapid conduction Precise control of depth Rapid elimation

less souble... means

readily leaves blood, faster induction and recovery

V partition coefficient->more insoluble or soluble?

more insoluble, means faster onset and recovery

Name the inhaled anesthetics in increasing partition coefficient and increasing solubility

Name the inhaled anesthetics in increasing onset and recovery

Iso, sevo, des, no

Physiochemical property affecting stability and potency

chemical structure

physiochemical property affecting amount of inhalant delivered

vapor pressure

physiochemical property affecting kinetics within body

solubility

does potency = efficacy

Dose required to reach a desired effect

Potency

increasing MAC does what to potency

decreases

MAC of Iso

1.14-1.5

MAC Sevoflurane

2.1-2.4

MAC Desflurane

7.2-10.3

hyperthermia, atremia, CNS stimulation and increased excitatory NTS does what to MAC

increased MAC

Other anesthetics, hypothermia, atremia, tension, decreased O2, increased CO2, pregnancy, old age

decreased MAC

Gender, normal respiration gas concentration, duration of anesthesia, metabolic alkalosis/acidosis, anemia does what to MAC

does not do anything

THREE FACTORS THAT INFLuENCE UPTAKE OF INHALED ANESTHETICS

solubility Cardiac output alveolar-venous anesthetic PP difference

Increase in CO, does what to uptake and induction

uptake->prolongs induction time

elimination is dependent on...

inhaled solubility, CO, duration

Inhaled anesthetics do what to CNS

increase BF and ICP

what does inhaled anesthetics do to cardiac output?

decrease, it is a negative ionotrope and decrease resistance by decreasing BP

Which inhaled anesthetic is more liver friendly

Iso because most likely to maintain BF

What happens in swine with a mutation in RYR1 receptor

Malignant hyperthermia

Analgesia is great Sedation ok Safe Reversible

Opioid

which opioid is the least analgesia

Butophanol (works on kappa, competitive antagonist at mu)

What opioid has the most analgesia

hydromorphone, morphine, fetanyl

Which opioid is a medium analgesia

Bupreophrine

What is the reversal for opioids

Naloxone

analgesia ok sedation great lots of side effects: vasoconstriction (heart has to work more), hypoperfusion to other organs besides heart and brain, worse in hypovolemia, AV block, braycardia

Alpha 2 agonist

Reversals for alpha 2 agonists sedation

Yohimbine: weaker for xylazine | Antipamazole

Duration of xylazine

short duration

Duration of Detomidine

moderate

Duration of Romifidine

moderate

Duration of dexmedetomidine

Long

Name 4 alpha agonist used in sedation

xylazine Detomidine Romifidine dexmedetomidine

``` No analgesia Ok sedation NOT reversible Highly protein bound hepatic metabolism Side effect: vasodilation ```

acepromazine

no analgesia sedation mild safe reversible

Benzodiazepines: diazepam, midazolam, zolazepam

reversal for benzodiazepines

Flumazenil

the 3 benzodiazepines

diazepam midazolam zolazepam

Therapeutic index for etomidate

Therapeutic index for ketamine

^^^

Therapeutic index alfaxolone

>20

Therapeutic index propofol

Therapeutic index of thiopental

For most injectable anesthetics time of awakening is dependent on what phase?

redistribution NOT elimination

time it takes to wake up once RRI is discontinued

context sensitive 1/2 life

``` MOA: GABA change in durations Dose dependent CNS depression no analgesia, CVS depression acids hepatic metabolism ```

Barbituates: pheno and thiopental

Do injectable anesthetics have analgesia effects?

NOOOOOOO

Decreases CBF and ICP: good for brain Bad for CRI and liver B

Thiopental

``` Short acting/fast clearance recovery due to redistribution smooth induction and recovery short context sensitive 1/2 life (good for infusion rate) MOA: GABA good for liver Bad for heart and respiratory depression ```

Propofol

Complications of propofol

vehicle is composed of soy bean oil and lecithin can get bacterial growth, fat embolization, increase plasam triglyceride Bad for pancreatitis or mixing with stuff

Was thought to be the ideal anesthetic great for heart and brain and respiration but inhibits 11-beta-hydroxylase (which converts cholesterol to glucocorticoids) SO bad for adrenals

Etomidate

Dissociative analgesia Do not use by itself Block GLU on NMDA receptor (non competitive) is an analgesia strong CV activation, increased muscle tone blocks catecholime uptake (increases sympathetic effects)

Ketamine

Expensive injectable analgesia that works on GABA and is pretty good overall

Alfaxalone

Which injectable anesthetic would you want to use in an old dog/cat with.... heart failure kidney failure Liver failure

etomoldine (2nd alfa) Alfaxalone (2nd dex) propofol (2nd alfa)

Which injectable anesthetic would you want to use in trauma case with.... hypovolemia shock head injury septic shock

ket/dex (2nd alfax) really thiopental, but not available so propofol (2nd alfa) Ket/Dex (2nd alfa)

"extrapyramidal side effects (tremors, rigidity, and decreaed activity) is caused by

DA antogonist, DA is important for central control of voluntary movements

Exam 3 Flashcards

(170 cards)