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Cardiology > Lecture 10: Clinical Pharmacology > Flashcards

Lecture 10: Clinical Pharmacology Flashcards

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1
Q

What is the only -ve chronotrope AND +ve inotrope?

A

Glycosides e.g. digoxin

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2
Q

What do positive inotropes do?

A

Increase contractility (so increase stroke volume and decrease need for reflex increases in rate)

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3
Q

How does digoxin work?

A

Na/K pump inhibitor

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4
Q

What are some ways digoxin acts as a -ve chronotrope?

A

Stimulates vagus, increases AV refractoriness, slows SA depolarisation, decreases sympathetic tone

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5
Q

Why should you be careful giving digoxin to fat dogs?

A

Lipophilic, long elimination half life

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6
Q

What are some GI effects of digoxin?

A

Anorexia, pain, vomiting, diarrhoea

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7
Q

What causes the GI toxicity in digoxin?

A

Vagal effects

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8
Q

Which arrhythmias can digoxin cause?

A

Any

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9
Q

What should you do in digoxin toxicity?

A

stop giving drug, anti-arrhythmics if life threatening, antibodies, activated charcoal

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10
Q

Which drugs can digoxin interact with?

A

Those which cause electrolyte changes, those which affect GI absorption, those which cause changes in cardiac cell activity

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11
Q

Which drugs can digoxin increase plasma concentrations of?

A

Ca blockers, ACE inhibitors, anti-arrhythmics, diuretics

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12
Q

Which drugs can digoxin decrease plasma concentrations of?

A

Thyroid hormones

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13
Q

Which drugs can cause additive depression of AV conduction along with digoxin?

A

Ca blockers, PS-mimetics

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14
Q

How does B1 affect heart?

A

increased force of contraction, increased heart rate

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15
Q

How does B2 affect heart?

A

vasodilation in skeletal muscles

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16
Q

How does a1 affect heart?

A

vasoconstriction

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17
Q

Which sympathomimetic has the lowest potential for arrhythmias?

A

Dobutamine

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18
Q

In what conditions do you give dobutamine?

A

CHF or increasing contractility

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19
Q

How long can the effects of dobutamine last?

A

Weeks

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20
Q

What are some side effects of sympathomimetics?

A

Arrhythmias, hypoK, increased peripheral resistance, GI stasis, dysuria, restlessness.

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21
Q

Which drugs given with sympathomimetics cause Increased risk of arrhythmias
?

A

Anaesthetics, glycosides, anything disturbing electrolytes

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22
Q

Which drugs can enhance the sympathetic effects of sympathomimetics?

A

Anti-cholinergics, PDE inhibitors, thyroid supplementation

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23
Q

What is pimobendan?

A

A PDE inhibitor

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24
Q

How do you give pimobendan?

A

IV or orally

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25
How do PDE inhibitors work?
Ca sensitizer, increased force of contraction, reduced pre-load and afterload, +ve inotrope
26
How do methyxanthines work?
PDE inhibition, adenosine receptor antagonism (so vasodilatory)
27
What are the effects of methyxanthines?
relax vascular smooth muscles, CNS stimulation, stimulate cardiac muscle, weak diuretics, bronchodilation
28
What are signs of methyxanthine toxicity?
restlessness, agitation, excitement, tachycardia, gastric irritation, seizures
29
How do you treat methyxanthine toxicity?
CHarcoal, diazepam toxicity (seizures), propranolol (tachycardia)
30
What are signs of chronic methyxanthine toxicity?
vomiting, anxiety, restlessness, cardiac extrasystoles, seizures
31
How do nitrates e.g. nitroglycerine work?
Vasodilators
32
What are methods of administration of nitrates?
Tablets, topical patches, ointments
33
What are two side effects of nitroglycerine?
Hypotension, methaemoglobinaemia, dermatitis
34
Which drugs can nitrates interfere with?
Sympathomimetics, heparin, vasodilators, diuretics, beta blockers
35
What are side effects of nitroprusside?
excessive vasodilation and hypotension, nausea, vomiting, loss of consciousness, reflex tachycardia, accumulation of thiocyanate with prolonged use (toxic psychosis, metabolic acidosis, MM pink)
36
How does hydralazine work?
vasodilator (reflex tachycardia, relaxes smooth muscle, increases heart rate and stroke volume)
37
What are side effects of hydralazine?
Hypotension, constipation, diarrhoea, lupus-like syndrome
38
Which drugs reduce effects of hydralazine?
NSAIDs, oestrogens, sympathomimetics
39
Which drugs enhance effects of hydralazine?
other vasodilators, diazoxide and other hypertensive drugs
40
In which conditions is hydralazine used?
congestive heart failure severe mitral regurgitation reduction of left atrial enlargement
41
How does prazosin work?
α1-antagonist | reduces mean arterial pressure
42
What are some side effects of prazosin?
Hypotension, loss of consciousness, tachycardia
43
When do you use prazosin?
To reduce afterload
44
Why is prazosin not commonly used?
Get tolerance, poor long-term response
45
What is the most common ACE-inhibitor?
Benazepril
46
What are three effects of ACE inhibitors?
reduce arterial resistance, reduce venous tension, reduce aldosterone secretion
47
In what condition should you reduce dose of ACE inhibitors?
Renal failure - reduce by 50%
48
What impairs absorption of ACE inhibitors?
Food
49
In which condition do you use ACE inhibitors?
CHF
50
What are some side effects of ACE inhibitors?
GI issues, hypotension, hyperK, neutropenia, preoteinuria, hypersensitivity, renal failure
51
Which drugs interact with ACE inhibitors?
Diuretics, beta blockers, NSAIDs, oestrogens, sympathomimetics, K supplements
52
What are three mechanisms of thiazide diuretics?
Block facilitated Na/Cl co-transport, K-wasting effect, increased distal tubule Ca reabsorption
53
In which patients should you not use thiazide diuretics?
HyperCa
54
What are five side effects of thiazine diuretics?
electrolyte imbalances, agranulocytosis, allergic reactions, hyperuremia, thrombocytopenia,
55
How long do thiazide diuretics act for?
6-12 hours
56
What are some clinical uses of thiazine diuretics?
Oedema from CHF, hepatic cirrhosis, oestrogen therapy, udder oedema, DI
57
What are some clinical uses of furosemide?
Oedema from CHF, hepatic cirrhosis, renal disease
58
Which diuretic may be more appropriate in hepatic cirrhosis?
Spironolactone
59
What will loop diuretics eventually result in?
HypoK
60
Which conditions reduce oral bioavailability of loop diuretics?
Renal failure and CHF
61
What is half life of loop diuretics?
1-2 hours
62
What prolongs half life of loop diuretics?
Hepatic and renal disease
63
What are some side effects of loop diuretics?
Electrolyte imbalance, allergies, ototoxicity, pancreatitis, leukopenia, agranulocytosis, thrombocytopenia
64
Which drugs reduce effects of loop diuretics?
NSAIDs
65
Which drugs do loop diuretics potentiate?
ACE inhibitors, NMJ blockers
66
Which drugs do loop diuretics potentiate the oto or nephrotoxic effects of?
amphotericin B, aminoglycosides etc
67
Along with which drugs do loop diuretics potentiate hypoK?
amphotericin B, mineralocorticoids, some penicillins
68
Which drugs do loop diuretics decrease activity of?
anti-coagulants, enzymes, insulin
69
What are two examples of K-sparing diuretics?
Spironolactone, triamterene
70
How can K-sparing diuretics work in CHF?
Limit aldosterone effects rather than direct diuretic effect
71
WHich drugs can K-sparing diuretics interact with?
Other affecting Na/K balance
72
What are two clinical uses of K-sparing diuretics?
Decrease hypoK from other diuretics, oedema and ascites from cirrhosis and portal hypertension
73
What are some side effects of K-sparing diuretics?
Adrenal and sex hormone effects with long-term use, electrolyte imbalances
74
What is the active ingredient of activyl?
Indoxacarb
75
What is the problem with activyl?
Only does fleas
76
What is active ingredient of stronghold?
Selamectin
77
What is active ingredients of stronghold plus?
Selamectin and sarolaner
78
What is active ingredient of bravecto?
Fluralaner
79
What is the problem with bravecto?
Epileptogenic
80
Which species is permethrin toxic to?
Cats and fish
81
What other disease should you consider if fleas?
Tapeworm, as fleas intermediate host
82
How can humans catch dipylidium?
Eating a flea
83
Which breed can get severe immune-mediated reaction following potentiated sulphonamides?
Doberman

Cardiology (9 decks)

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