Exam 4 - Cardiovascular Pharmacology

Question 1

electrical malfunction - _________
valve leakage - _______ _______
pump failure (cold) - ______________
congestive heart failure - ________
vessel abnormalities (narrow or blocked) - ________

Answer 1

electrical malfunction - arrhythmias
valve leakage - valve disease
pump failure (cold) - cardiomyopathy
congestive heart failure - drowning
vessel abnormalities (narrow or blocked) - hypertension

Question 2

what are the goals in using drugs to treat cardiovascular disease?

Answer 2

control arrhythmias, resolve congestion, improve contractility, resolve clinical signs, & maintain/improve quality of life

Question 3

T/F: drug interactions are possible & likely in cardiovascular drugs

Answer 3

true

Question 4

what is preload?

Answer 4

pressure stretching the ventricle of the heart after passive filling of the ventricle & subsequent atrial contraction (volume)

Question 5

what are some drugs that are preload reducers?

Answer 5

diuretics!!!!

nitroglycerine paste & ace inhibitors

Question 6

what is the difference in clinical signs between left & right sided heart failure?

Answer 6

left sided - pulmonary edema

right sided - ascites

Question 7

what is the mechanism of action of loop diuretics?

Answer 7

inhibit the highly reabsorptive NaKCl co-transporter in the ascending limb of the loop of henle & cause potassium wasting

Question 8

what are the adverse effects of loop diuretics?

Answer 8

dehydration & electrolyte abnormalities

Question 9

what drugs are commonly used loop diuretics for cardiac disease?

Answer 9

furosemide & torsemide

Question 10

what kind of drug is spironolactone?

Answer 10

aldosterone receptor antagonist

Question 11

what is the mechanism of action of spironolactone?

Answer 11

blocks Na & K transport in the distal tubule & collecting ducts leading to Na excretion

antifibrotic effect by blocking RAAS

potassium sparing

Question 12

what is the diuretic effect of spironolactone?

Answer 12

minimal

Question 13

what is the mechanism of action of hydrochlorothiazide?

Answer 13

inhibits the reabsorption of Na & Cl in the distal tubule & causes potassium wasting

Question 14

what are the adverse effects associated with hydrochlorothiazide?

Answer 14

dehydration & electrolyte abnormalities

Question 15

label the drugs that work at each number

Answer 15

1. loop diuretics
2. thiazides
3. spironolactone

Question 16

what is an inotrope?

Answer 16

agent that alters the force of the heart muscle contraction

Question 17

what do negative inotropic agents do?

Answer 17

decrease the force of muscular contraction

Question 18

what do positive inotropic agents do?

Answer 18

increase the strength of muscular contraction

Question 19

what are some examples of negative inotropic drugs?

Answer 19

beta blockers & calcium channel blockers

Question 20

what are some examples of positive inotropic drugs?

Answer 20

dobutamine!! - IV

pimobendan! - PO

digoxin - PO

Question 21

what is the mechanism of action of pimobendan?

Answer 21

positive inotrope - calcium sensitization & PDE III inhibitor that causes balanced arterial & venous vasodilation

leads to improved forward blood flow

Question 22

what is afterload?

Answer 22

pressure the left ventricle has to generate in order to eject blood into the aorta - the pressure in the ventricle must be greater than the systemic pressure in order to open the aortic valve

Question 23

what are some examples of drugs that are afterload reducers?

Answer 23

amlodipine & telmisartan

hydralazine

ace inhibitors

Question 24

what is the ideal blood pressure?

Answer 24

110-120 mmHg

Question 25

what happens if you have a blood pressure < 90 mmHg?

Answer 25

clinical evidence of low cardiac output, weak & lethargic animal, & need to use careful administration of any afterload reduced

Question 26

what happens if you have a blood pressure > 160 mmHg?

Answer 26

monitor patient for evidence of end organ damage & afterload reduction

Question 27

what is the primary effect of antihypertensive medications?

Answer 27

lower blood pressure

Question 28

what drug is used in both dogs & cats to lower blood pressure?

Answer 28

amlodipine - calcium channel blocker

Question 29

what drug is used in cats to lower blood pressure?

Answer 29

telmisartan - semintra, angiotensin II receptor blocker

Question 30

what drug is used in dogs to lower blood pressure?

Answer 30

hydralazine

Question 31

what is the equation of blood pressure?

Answer 31

blood pressure = cardiac output X systemic vascular resistance

Question 32

T/F: pimobendan is an antihypertensive medication

Answer 32

false - positive inotrope & vasodilator

Question 33

what drug is commonly used as an additional effect for antihypertension?

Answer 33

ace inhibitors - enalapril & benazepril may decrease BP by 5-10 mmHg, but it's not typically used as a monotherapy for systemic hypertension

Question 34

when looking at calcium channel blocking drugs, between DHPs & NON-DHPs, which is more vascular selective?

Answer 34

DHPs - more vascularly selective NON-DHPs - act equally on the heart & the arterioles

Question 35

what are examples of DHPs & NON-DHPs drugs?

Answer 35

DHPs - amlodipine NON-DHPs - diltiazem

Question 36

what neuroendocrine response does the body have to cardiac disease?

Answer 36

maladaptive response from the RAAS cascade & sympathetic nervous system

Question 37

what is the RAAS cascade?

Answer 37

hormone system that regulates blood pressure & water balanced with end products of angiotensin II & aldosterone promotes vasoconstriction & sodium/water retention

Question 38

what drugs are used as a blockade to the RAAS cascade?

Answer 38

ace inhibitors, anti-aldosterone, & angiotensin II blockers

Question 39

what effects are seen in the sympathetic nervous system in response to cardiac disease?

Answer 39

constant adrenergic stimulation to the heart - B1 down regulates, but B2>B1 becomes counter productive in heart failure - b mediated tachycardia & a mediated vasoconstriction

Question 40

what drugs are used for a blockade of the sympathetic nervous system when a maladaptive response is present due to cardiac disease?

Answer 40

selective (atenolol) beta blockers or non-selective negative chronotropes/inotropes only use these in STABLE PATIENTS

Question 41

what are chronotrophic drugs?

Answer 41

drugs that change the heart rate and/or rhythm

Question 42

what do positive chronotropes do?

Answer 42

increase heart rate - anticholinergics (atropine, glycopyrrolate)

Question 43

what do negative chronotropes do?

Answer 43

decrease heart rate & reduce arrhythmias - beta blockers & calcium channel blockers these drugs typically have other important effects (negative inotrope)

Question 44

do patients with DCM have a decrease or increase in ventricular muscle contractility?

Answer 44

decrease - need a positive inotrope

Question 45

where do patients with left-sided heart failure accumulate fluid?

Answer 45

pulmonary edema - need a drug to reduce preload

Question 46

what neuroendocrine system are activated in heart failure?

Answer 46

RAAS - need to block RAAS activation

Question 47

what is congestive heart failure?

Answer 47

condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body

Question 48

what is DCM?

Answer 48

condition in which the heart becomes weakened, enlarged, & cannot pump blood efficiently

Question 49

what drugs are useful for ventricular arrhythmias?

Answer 49

lidocaine, procainamide, sotalol, & amiodarone

Question 50

what drugs are useful for both supraventricular & ventricular arrhythmias?

Answer 50

procainamide & quinidine