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Pharmacology II > Autonomic and Cardiac Review > Flashcards

Autonomic and Cardiac Review Flashcards

1
Q

what is the main neurotransmitter of cholinergic NS

A

acetylcholine

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2
Q

what is the main neurotransmitters of the adrenergic NS

A

epinephrine, NE, DA

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3
Q

what is the main result of an alpha1 receptor agonist

A

vasoconstriction, increase BP

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4
Q

what is the main result of a beta1 receptor agonist

A

increase HR and contractility

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5
Q

what is the main result of a beta2 receptor agonist

A

dilation, bronchodilation

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6
Q

Does an M receptor agonist increase activity in PNS or SNS

A

PNS

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7
Q

what receptor does bethanecol target and agonist or antagonist

A

M receptor agonist

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8
Q

what is bethanecol indicated for

A

decreased bladder contractility, equine gastric ulcer syndrome (increase activity of PNS)

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9
Q

when are some examples of when bethanecol would be contraindicated

A

obstruction, gastric ulcers in small animals, hyperthyroidism (cause a-fib), hypotension, bradycardia, vagal nerve dysfunction, asthma (bronchoconstriction), hx recent GI sx

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10
Q

In myasthenia gravis, what does the drug want to inhibit

A

cholinesterase

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11
Q

what is the diagnostic drug of choice for myasthenia gravis

A

neostigmine

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12
Q

what is a potential adverse effect of neostigmine

A

cholinergic overdose-hypotensive, bradycardic, bronchoconstriction

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13
Q

what is the drug of choice in treating myasthenia gravis

A

pyridostigmine bromide

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14
Q

what are some adverse effects of pyridostigmine bromide

A

downregulate Mn receptors so constantly need to increase dose, can lead to intussception

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15
Q

is atracurium a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist (decrease PNS activity)

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16
Q

what are the indications for atracurium

A

unblocking male cats and to paralyze animals

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17
Q

T or F: animals who received atracurium receive both an analgesic and pain relief effect

A

false! it just paralyzes them but they can feel everything

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18
Q

what is the order of muscles that become paralyzed with atracurium

A
  1. first small muscles become weak, flaccid, paralyzed
  2. small muscles
  3. large muscles
  4. abdominal and laryngeal muscles
  5. respiratory muscles
    **recover in reverse order
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19
Q

what drug is used to reverse the effects of atracurium

A

acetylcholinesterase inhibitors like neostigmine

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20
Q

is atropine sulfate a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist

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21
Q

what receptor does atropine sulfate act on

A

M receptor competitive antagonist

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22
Q

what are the labeled used of atropine sulfate

A
  1. decrease secretions pre-anesthesia
  2. bradycardia, sinoatrial arrest, incomplete AV blocks
  3. vagally mediated or primary bradycardia
  4. tx cholinergic toxicities
  5. pain secondary to uveal or corneal dz
  6. dilation
  7. synechia breakdown
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23
Q

what effect does atropine sulfate have on the eyes

A

dilation, blocks accommodation, dry eyes, and increase IOP

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24
Q

what is an adverse effect of atropine sulfate in horses

A

colic (decreasing PNS activity)

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25
Q

is glycopyrolate a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist

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26
Q

what are some indications of glycopyrolate

A
  1. pre-med for dogs and cats (labeled)
  2. bradycardia (ELDU)
  3. counteract imidiocarb in horses (ELDU)
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27
Q

you are trying to choose between using glycopyrolate or atropine sulfate in pregnant dog who is bradycardia under anesthesia, which is better

A

glycopyrolate- quaternary amine so has a lower distribution so won’t cross placenta, milk or CNS like atropine sulfate will

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28
Q

is oxybutinin chloride a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist

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29
Q

what is oxybutinin chloride indicated for

A

detrusor hyperreflexia in dogs

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30
Q

what are some potential side effects of oxybutinin chloride

A

tachycardia, bronchodilation, increase IOP (decrease PNS/increase SNS)

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31
Q

what are some contraindications for oxybutinin chloride

A

blocked patients, tachycardia, glaucoma

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32
Q

is isoproterenol a cholinergic or adrenergic agonist or antagonist

A

adrenergic agonist

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33
Q

what receptors does isoproterenol act on

A

direct acting B1 (increase HR and contractility) and B2 (bronchodilation) agonist

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34
Q

what are some indications for isoproterenol

A
  1. bradycardic-B1 receptor
  2. acute bronchoconstriction-B2 receptor
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35
Q

what are some adverse effects of isoproternol

A

hypotension, tachycardia

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36
Q

is epinephrine a cholinergic or adrenergic agonist or antagonist

A

agonist

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37
Q

what receptors does epinephrine act on

A

alpha1 (high dose), B1 (low dose)

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38
Q

what are some indications for epinephrine

A
  1. cardiac arrest, bradycardia (B1-low dose)
  2. anaphylaxis (alpha1-vasoconstriction)
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39
Q

is NE a cholinergic or adrenergic agonist or antagonist

A

adrenergic agonist

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40
Q

What are the indications of NE

A

Hypotension in dogs, cats and foals

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41
Q

What are some adverse effects of NE

A

Hypertension, arrhythmias, seizures

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42
Q

Is dopamine HCl a cholinergic or adrenergic agonist or antagonist

A

Adrenergic agonist

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43
Q

What are some indications for dopamine HCl

A

Hypotension in dogs and cats

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44
Q

What does low dose dopamine target/cause

A

DA receptors in renal and mesenteric vasculature causing dilation

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45
Q

What does high dose dopamine target/cause

A

Target alpha1 receptors resulting in vasoconstriction

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46
Q

Is phenylephrine a cholinergic or adrenergic agonist or antagonist

A

Adrenergic agonist

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47
Q

What receptor does phenylephrine HCl act on

A

Direct acting alpha1 agonist

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48
Q

What are some indications for phenylephrine HCl

A
  1. Hypotension in cats and dogs
  2. Ascending colon displacement in horses
  3. Ophthalmic solution- induce myriadsis without loss of accommodation
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49
Q

When can phenylephrine be used in emergency situations

A

To increase BP if fluid blouses and atropine already on board or to increase CO without contractility or HR

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50
Q

What are some adverse affects of phenylephrine

A

Reflex bradycardia, hypertension, colic, hemorrhage, necrosis

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51
Q

What are some contraindications with phenylephrine

A

Arrhythmia or bradycardia, hypertension, renal or hepatic insufficiency, elderly, hyperthyroidism

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52
Q

Is dobutamine a cholinergic or adrenergic agonist or antagonist

A

Adrenergic agonist

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53
Q

What receptor does dobutamine act on

A

Direct acting B1 agonist

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54
Q

What are some indications for dobutamine HCl

A

Tx acute heart failure

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55
Q

What are some adverse affects of dobutamine

A

Tachycardia, arrhythmias, seizures

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56
Q

What are some contraindications for dobutamine

A

Subaortic stenosis, hypovolemia, myocardial infarction, arrhythmias, hypersensitivity

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57
Q

Which receptors does albuterol, clenbuterol, and terbutaline act on and what are they indicated for

A

Direct acting b2 agonists- indicated for bronchoconstriction

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58
Q

Is phenylpropanolamine a cholinergic or adrenergic agonist or antagonist

A

Adrenergic agonist

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59
Q

What are some indications for phenylpropanolamine

A

Urinary incontinence

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59
Q

What receptor does phenylpropanolamine act on

A

Mixed acting adrenergic agonist

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60
Q

What are some adverse effects of phenylpropanolamine

A

Urine retention, tachycardia, hypertension

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61
Q

What are some contraindications for phenylpropanolamine

A

Glaucoma, prostatic hypertrophy, hyperthyroidism, DM, CVD, kidney insufficiency, hypertension

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62
Q

Is ephedrine sulfate a cholinergic or adrenergic agonist or antagonist

A

Adrenergic agonist

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63
Q

What are some indications for ephedrine sulfate

A
  1. Hypotension associated with anesthesia in dogs, cats and horses
  2. Urinary incontinence but rarely used
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64
Q

What receptor does ephedrine sulfate act on

A

Mixed acting adrenergic agonist

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65
Q

Is prazosin a cholinergic or adrenergic agonist or antagonist

A

Adrenergic antagonist

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66
Q

What receptor does prazosin act on

A

Competitive Alpha1 antagonist

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67
Q

What are some indications for prazosin

A
  1. Functional urethrospasm in dogs
  2. Hypertension in dogs and cats
  3. Adjunctive in CHF management with digoxin
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68
Q

Is phenoxybenzamine HCl a cholinergic or adrenergic agonist or antagonist

A

Adrenergic antagonist

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69
Q

What receptor does phenoxybenzamine HCl act on

A

Non competitive alpha1 antagonist

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70
Q

What are some indications for phenoxybenzamine

A
  1. Functional urethrospasm in dogs, cats and horses
  2. Pheochromocytoma
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71
Q

How does phenoxybenzamine treat a pheocrhomocytoma

A

Tumor releases NE and Epi cause severe hypertension, tachycardia, and arrhythmia. Phenoxybenzamine is a non-competitive alpha1 antagonist so will block alpha1 therefore avoiding vasoconstriction

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72
Q

What are some adverse effects of alpha1 antagonists

A

Hypotension, reflex tachycardia, nasal congestion, lethargy, GI effects, miosis, increased IOP, inhibit ejaculation

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73
Q

What are some contraindications for alpha1 antagonists

A

CHF, hypotensive, renal failure, colic, glaucoma

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74
Q

Are the following B1 or B1/2 antagonists: atenolol, esmolol, metoprolol. And what is their function

A

B1 antagonists- decreased HR and contractility

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75
Q

Are the following B1 or B1/2 antagonists: propranolol, sotalol, timolol. And what is their function

A

B1/2 antagonist: decrease HR and contractility (B1) and vasodilation (B2)

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76
Q

When are B-antagonists used

A

Tachycardic, hypertension

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77
Q

Which B-antagonists have a mild local anesthetic activity and what is mechanism

A

Propranolol and metoprolol via Na+ blockade

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78
Q

Which B-antagonists caused a marked decrease in HR in healthy cats and is contraindicated in cats with cardiac disease

A

Timolol

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79
Q

Which B antagonist is fast acting with short duration and usually used as diagnostic tool

A

Esmolol

80
Q

Which B-antagonist can treat thyrotoxicosis

A

Propranolol

81
Q

What are some adverse effects of B-antagonists

A

Bradycardia, bronchoconstriction, hypotension

82
Q

What are some contraindications of B-antagonists

A

CVD, asthma/RAO, renal or hepatic insufficiency, DM

83
Q

What class of drugs are furosemide, spironolactone, and hydrochlorothiazide

A

Diuretics

84
Q

What class of drug are enalapril, benazepril, lisinopril, rampipril

A

ACE inhibitors

85
Q

What class of drug is pimobendan

A

Calcium sensitizer

86
Q

What class of drug is digoxin

A

Digitalis

87
Q

What class of drug is dobutamine and dopamine

A

Sympathomimetics

88
Q

What class of drug is carvedilol

A

Alpha and beta blocker

89
Q

What class of drug is diltiazem

A

Calcium channel blockers

90
Q

What is the result of hypertrophic cardiomyopathy

A

Impaired ventricular filling

91
Q

What drugs are most effective in treating HCM

A

ACE inhibitors and furosemide

92
Q

Where does furosemide act in tubular system

A

Loop diuretic

93
Q

What diuretic is used for acute heart failure

A

Furosemide

94
Q

T or F: furosemide should be used as a monotherapy in tx of chronic HF

A

False

95
Q

What are some adverse effects of furosemide

A

Excessive fluid and or electrolyte losses

96
Q

Which diuretic is primarily used to reduce exercise induced pulmonary hemorrhage in race horses

A

Furosemide

97
Q

Which diuretic is also known as the k-sparing diuretic

A

Spironolactone

98
Q

Which diuretic needs to be used cautiously in patients receiving ACEI or K supplement and why?

A

Spironolactone because can cause hyperkalemia

99
Q

What diuretic is contraindicated in hyperkalemic patients

A

Spironolactone

100
Q

Which diuretic can be used in adjunctive tx for hyperkalemic periodic paralysis in horses

A

Thiazide diuretics

101
Q

How do ACE inhibitors work

A

Block conversion of angiotensin I to active angiotensin II- effects RAAS system

102
Q

Angiotensin decreases the secretion of ___hormone which therefore decreases Na+ retention

A

Aldosterone

103
Q

What are some indications for ACE inhibitors

A

Chronic HF, DCM, chronic valvular insufficiency, HCM

104
Q

What is the drug of choice for systemic arterial hypertension in dogs

A

ACE inhibitors

105
Q

What are some adverse effects of ACE inhibitors

A

Renal function deterioration, hypotension, GI upset, hyperkalemia

106
Q

What are some common ACE inhibitors for HF

A

Enalapril, benazepril, ramipril, lisinopril

107
Q

Which ACE inhibitor is labeled for dogs

A

Enalapril

108
Q

What is the mechanism of action of pimobendan

A

Increases contractility by increasing myofilament sensitivity to Ca2+

Inhibits phosphodiesterase III which breaks down cAMP—> increase cAMP—> increase PKA—>activate L-type calcium channels—> increase myocardial contractions

109
Q

What are some indications for pimobendan

A

HF from DCM or chronic mitral valve disease

110
Q

What is the mechanism of action of digoxin

A

Binds and inhibits Na/K+ ATPase, decreases Na+/Ca2+ exchange therefore increase intracellular Ca2+—> increase contractility

111
Q

What anti arrhythmic effects does digoxin have

A

Against supraventricular tachycardia humans

112
Q

What is the max dose for digoxin

A

0.25mg/dog

113
Q

What interactions can cause increased digitalis toxicity

A

Hypokalemia, B-antagonists, calcium channel blockers, antibiotics

114
Q

How does potassium affect digitalis toxicity

A

Reduce toxicity

115
Q

How does calcium affect digitalis toxicity

A

Enhances toxicity

116
Q

What is the standard drug therapy for heart failure

A
  1. Diuretics (furosemide)
  2. ACE inhibitors
  3. Pimobendan
117
Q

Do drugs that act through nitric oxide dilate veins or arteries

A

Preferentially dilate veins but can dilate arteries

118
Q

How does hydrazoline affect arteries and veins

A

Dilates arterioles not veins

119
Q

What is hydrazine most effective in treating

A

CHF secondary to mitral valve insufficiency

120
Q

what is the purpose of calcium channel antaognists

A

Decrease cardiac contractility, reduced impulse generation in SA node and slowed AV conduction

121
Q

What is the mechanism of action of amlodipine besylate

A

Ca2+ channel blocker that causes vasodilation

122
Q

What is the drug of choice in hypertensive cats

A

Amlodipine besylate

123
Q

What is the mechanism of action of diltiazem

A

Depresses SA and at node

124
Q

When is diltiazem used

A

HCM in cats and supraventicular tachycardia in dogs

125
Q

Amlodipine or diltiazem: causes greater depression of SA and AV node and negative ionotropic

A

Diltiazem

126
Q

Amlodipine or diltiazem: causes greater vasodilation and reflex tachycardia

A

Amlodipine

127
Q

What is the mechanism of action of sildenafil

A

Selective inhibitor of cGMP and PDE5-producing vasodilation

128
Q

When is sidenafil used

A

Pulmonary hypertension in dogs

129
Q

What are the 2 aims of therapy of arrhythmias

A
  1. Reduce ectopic pacemaker activity
  2. Modify conduction or refractories to disable re-entry
130
Q

What do Class I anti-arrhythmics block

A

All block sodium channels

131
Q

What are the Class I A drugs

A

Quinidine and procainamide

132
Q

What do class I A drugs block

A

Preferential block open or activated sodium channels- lengthen the duration of action potential (increase ERP)

133
Q

What are the class I B drugs

A

Lidocaine

134
Q

What do class I B drugs do

A

Preferentially block inactivated sodium channels, shorten action potential and ERP

135
Q

What is the function of class II antiarrthymics

A

Reduce adrenergic activity

136
Q

What anti-arrhythmic class are beta blockers

A

Class II

137
Q

What is the function of class III anti-arrhythmics

A

K+ channel blockers and extend ERP

138
Q

What are the class III anti-arrhythmic drugs

A

Sotalol, amiodarone

139
Q

What is the function of class IV anti-arrhythmic drugs

A

Calcium channel blockers, decrease HR and contractility

140
Q

What class of anti-arrhythmics is diltiazem

A

Class IV

141
Q

What is the mechanism of action of quinidine

A

Binds to open and activated sodium channels- prolonging depolarization, AP and ERP

142
Q

Quindine can block muscarinic receptors which results in___

A

Increase HR and AV conduction

143
Q

What is the result of quinidine blocking alpha receptors

A

Hypotension, reflex tachycardia

144
Q

What arrhythmias does quinidine tx

A

Supraventricular, ventricular arrhythmias, and re-entrant arrhythmias

145
Q

When is quinidine contraindicated

A

Patients with MG, AV block, digitalis toxicity

146
Q

What are some adverse effects of quinidine

A

Hypotension, widened QRS, prolonged QT, AV block, ventricular tachycardia

147
Q

Which is more effective at treating ventricular arrhythmias: quinidine or procainamide

A

Quinidine

148
Q

What arrythmias does lidocaine tx

A

Ventricular origin

149
Q

T or F: lidocaine can be used orally

A

False, due to first pass effect

150
Q

What class II drug is used to reduce supraventricular tachycardia, a-fib or atrial flutter

A

Propranolol

151
Q

What class II drug is effective in treating supraventricular tachyarrythmias, systemic hypertension, and HCM

A

Atenolol

152
Q

What class II drug tx acute supraventicular tachycardia

A

Esmolol

153
Q

What drug is used to tx arrythmogenic cardiomyopathy in boxers

A

Sotalol

154
Q

When is diltiazem used

A

A-fib, supraventicular tachycardia, HCM

155
Q

What transporter does furosemide inhibit and what is the result

A

NKCC2, reduces Na+ absorption

156
Q

How do loop diuretics cause hypokalemia and alkalosis

A

Increase excretion of Mg2+ and Ca2+

157
Q

How do loop diuretics relieve pulmonary congestion

A

Increase PG synthesis and result in vasodilation

158
Q

What are some uses for furosemide

A
  1. Removal of edema fluid in HF
  2. Tx hypercalcemia by increasing Ca2+ excretion
  3. Prevents exercise induced pulmonary hemmorrhage and epitaxis in horses (likely due to Pg synthesis and dilation)
159
Q

What are some adverse effects of furosemide

A

Hypokalemia (increase digitalis toxicity), hypocalcemia, hypomagnesemia, hyponatremia, hypovolemia

160
Q

What receptor do thiazide diuretics act on

A

NCC in DCT, inhibit Na+ reabsorption

161
Q

What are some adverse effects of thiazide diuretics

A

Hypokalemia, hypercalemia

162
Q

When are thiazide diuretics used

A

Hyperkalemic periodic paralysis, long term HF, prevent calcium oxalate urotliths

163
Q

What is chlorothiazide used for

A

Dairy cattle to tx post -Sarum udder edema

164
Q

Where do potassium sparing diuretics/spironolactone act

A

ENAC, competitive inhibitor of aldosterone

165
Q

When is spironolactone used

A

CHF (unresponsive to furosemide), hepatic cirrhosis, nephrotic syndrome, and severe ascites

166
Q

When using spirnolactone what other heart drugs do you need to be cautious when using

A

ACE inhibitors and ARBS due to hyperkalemia

167
Q

When is mannitol used

A
  1. Acute renal failure
  2. Decrease IOP
  3. Decrease ICP
  4. Protect kidney against nephrotoxic substances
168
Q

What are some adverse effects of mannitol

A

Pulmonary edema in HF

169
Q

What type of inhibitor is acetazolamide

A

Carbonic anhydrase inhibitor

170
Q

What is the mechanism of action of acetazolamide

A

Inhibit CA enzyme, block HCO3- reabsorption, reduce Na+ reabsorption, increase Na/K+ exchange

171
Q

What is acetazolamide used for

A

Reduce aqueous humor production in glaucoma patients, conjunctive tx in HYPP

172
Q

What is the intrinsic coagulation pathway

A

Factor XII—> Factor XI—> Factor IX—> Factor VIII—> Factor X—< Factor V—< Factor II (thrombin)—> Factor I (fibrinogen)—> clot

173
Q

What is the extrinsic coagulation pathway

A

Tissue factor—> factor VII—> factor X—> factor V—> Factor II (thrombin)—> Factor I (fibrinogen)—> clot

174
Q

What are the vitamin K dependent coagulation

A

Factor II, Factor VII, Factor IX, Factor X

175
Q

What are some examples of hypercoaguable/ thromboembolic states

A
  1. Cats with HCM
  2. Dogs with IMHA
  3. Cushing dz
  4. Animals with acute phase inflammation
  5. Protein losing nephropathy
176
Q

What are some examples of hypoocoaguable states

A
  1. Post sx trauma intoxication
  2. Genetic bleeding diathesis
  3. Liver intoxication
  4. Liver failure
177
Q

What is warfarin sodium indicated for

A

Prophylactic treatment of thrombotic conditions

178
Q

What is the mechanism of action of warfarin sodium

A

Blocks vitamin K epoxide reductase—> decrease clotting factors

179
Q

What are some adverse effects of warfarin

A

Fatal hemorrhage associated with anemia, hematomas in any system

180
Q

What are the indications for vitamin K

A
  1. Rodenticide toxicity and moldy sweet clover
  2. Prolonged sulfonamide treatment of birds for coccidosis
  3. Congenital vitamin K dependent coagulopathy
  4. Porcine hemorrhagic syndrome
181
Q

What is the mechanism of action of vitamin K

A

Conjugates with y-glutamyl carboxylase and makes new y-glutamyl carboxylase (important to make clotting factors)

182
Q

IM and deep SC administration of heparin can cause ___

A

Hematomas

183
Q

Heparin requires the presence of what to work

A

Anti-thrombin III

184
Q

What are some adverse effects of heparin

A

Bleeding risk in dogs with IMHA, can cause IMTP and platelet activation

185
Q

What does rivaroxaban inhibit

A

Competitive inhibitor of Factor Xa

186
Q

Does rivaroxaban require anti-thrombin III to work

A

No

187
Q

What is mechanism of action of rivaroxaban

A

Blocks Factor Xa—> reduce clotting

188
Q

What is the mechanism of action of acetylsalicyclic acid

A

Irreversible inhibitor of COX-1 preventing thromboxane production (blocking platelet aggregation)

189
Q

What are some adverse effects of acetylsalicyclic acid

A

Life threatening metabolic acidosis, GI ulceration, nephrotoxicity

190
Q

What is the mechanism of action of clopidogrel bisulfate

A

Irreversible inhibition of platelet ADP receptor

190
Q

What are some contraindications of acetylsalicyclic acid

A
  1. Being a cat
  2. Hemorrhagic disorders
191
Q

What is the mechanism of collasate

A

Activates platelets by binding collagen receptors

192
Q

What are the indications for tissue plasminogen activator

A

Pulmonary thromboembolism, arterial thromboembolism

193
Q

What is the mechanism of action of tissue plasminogen activator

A

Activates plasminogen and promotes Fibrinolysis

194
Q

What are some indications for aminocaproic acid

A
  1. Post sx- bleeding
  2. Guttural pouch bleeding in horses
195
Q

What are the indications for tranexamic acid

A
  1. Post sx bleeding in dogs and cats
196
Q

What are some adverse effects of tranexamic acid

A

Consistently induces vomiting in dogs

Pharmacology II (18 decks)

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