Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Small Animal Cardiology > Cardiac Pharmacology > Flashcards

Cardiac Pharmacology Flashcards

1
Q

What are the effects of angiotensin converting enzyme (ACE) inhibitors?

A 
Balanced vasodilation
Reduce aldosterone release
Reduced glomerular capillary pressure 
Prevent angiotensin II mediated myocardial fibrosis and remodelling
Anti-adrenergic effects
Reduce vasopressin release 
Reduce endothelin release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is aldosterone escape?

A

Despite adequate ACE inhibition, aldosterone levels may increase due to the stimulation of aldosterone release from the adrenal cortex by other mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you block aldosterone escape?

A

Aldosterone antagonism eg: Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the targets of drug therapy in congestive heart failure?

A
  1. Counteracting oedema and effusions
  2. Counteracting neuro-endocrine activation
  3. Counteracting vasoconstriction
  4. Improving cardiac output
  5. Counteracting high sympathetic drive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs can you use to counteract Odense and effusions?

A

Diuretics - furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Furosemide

A

Loop diuretic
Oral administration for daily use
IV Administration for emergency (also venodilator when given IV)
Once patient is stable titrate does to effect

Ask owners to monitor response by monitoring respiratory rate

Side effects: pre-renal azotaemia, hypokalaemia

Should not be used on its own in the long term - ACE inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do you need to monitor in patients on furosemide?

A

Urea and creatinine

K+, Na+, Cl-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is furosemide contraindicated?

A

Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why might diuretic resistance occur?

A

GI tract oedema
Furosemide resistance - tubular hypertrophy
Concurrent NSAID therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should you do if diuretic resistance is occurring?

A

Increase dose of furosemide - 3 mg/kg TID max dose
Introduce other diuretics
- Torasemide - very potent but high risk of AKI
- Spironolactone
- Amiloride / hydrochlorothiazide
- Hydroflumethiazide / Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spironolactone

A

Weak potassium sparing diuretic
Aldosterone antagonist
(prilactone)
Significantly increases survival in CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hydrochlorothiazide

A

Thiazide diuretic that acts on the DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Amiloride

A

K+ sparing diuretic acts on the PCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where are diuretics definitely contraindicated?

A

Pericardial effusion - patients have low blood pressure due to cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How else can you treat effusions?

A

Thoracocentesis to drain pleural effusion
- obtain a sample for testing

Abdominocentesis - only in patients with serve respiratory compromise as protein rich exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drugs can you use to counteract neuro-endocrine activation?

A

Angiotensin converting enzyme inhibitors

Aldosterone antagonists - Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the effects of ACE inhibitors?

A 
Balance vasodilators
Reduces cardiac remodelling
Reduces aldosterone release 
Reduces sympathetic activation
Reduces vasopressin release 
Reduces endothelin release 
Increases the vasodilators bradykinin and prostaglandin 
Reduces the risk of glumerular hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the benefits of ace inhibitors?

A

Increased quality of life and survival time
Slows down progression to DCM
Reduces wall thickness in HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name the 4 ace inhibitors used in practice.

A

Benazepril
Enalapril
Ramipril - highest levels in the tissues
Imidapril - liquid preparation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What ace inhibitors are licensed?

A

Dog - all 4

Cat - none! Benazepril is licensed in for CKD so use this under the cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the side effects of ace inhibitors?

A 
Hypotension 
Renal impairment 
Hyperkalaemia
Anorexia
Diarrhoea 
Vomiting 
Cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When are ace inhibitors contraindicated?

A

Hypotension animals on high doses of furosemide

Aortic stenosis - aortic outflow tract obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What drug combinations are indicated to prevent aldosterone escape and Hyperkalaemia?

A

Spironolactone + furosemide + ace inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you unload the failing heart?

A

Arteriodilators
Venodilators
Mixed vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do arteriodilators do to unload the heart?

A

Redistribute the blood to the periphery, reducing mean arterial blood pressure and reducing afterload on the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name some pure arteriodilators.

A

Amlodipine
Hydralazine
ACE inhibitors - Benazepril etc

Pimobendan - mixed venodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When are arteriodilators useful / indicated?

A

Mitral valve disease
Reduce regurgitant flow
Reduce afterload
Increase forwards stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do venodilators work to unload the failing heart?

A

Diverts the blood away from the cardiopulmonary circuit

Eg: IV furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are mixed vasodilators?

A

Ace inhibitors

Pimobendan (also a major positive inotrope)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What category of drugs increase contractility?

A

Positive inotropes - calcium sensitiser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pimobendan

A

Sensitises the cardiac myocyte to calcium - positive inotrope
Balanced venodilator - reduces myocardial work load

Reduced risk of arrhythmias compared to other PDE inhibitors that increase intra-cellular calcium concentrations

Given orally in a palatable tablet - must give 1 hour before feeding

32
Q

What is the best protocol for dogs with DCM?

A

Pimobendan + diuretics + ace inhibitors + digoxin

33
Q

How can you counteract sympathetic drive?

A

Digoxin

Beta blockers

34
Q

When are beta blockers contraindicated?

A

Uncontrolled congestive heart failure

Poor contractility

35
Q

What are the effects of digoxin?

A

Negative chronic rope
Weak positive inotrope
Reduces sympathetic tone and increases vagal tone

= slows the rate of depolarisation through the AV node

36
Q

Digoxin

A

Liquid elixir has between absorption than tablets
Effects are seen in 6-8 hours
Takes 5 days for plasma levels to reach a steady state

37
Q

What monitoring is required with the use of digoxin?

A

Check the drug level after 7 days of treatment

Aim for low end of therapeutic range

38
Q

What are the side effects of digoxin?

A 
Borborygmi
Depression
Anorexia
Vomiting and diarrhoea
Cardiac arrhythmias
39
Q

What patients are at a greater risk of digitoxicity?

A 
Thin
Obese
Ascites
Hypoproteinaemia
Hypothyroidism 
Impaired renal function 
Dobermann
Hypoxia / acidosis 
Hypokalaemia
40
Q

How can you prevent digitoxicity?

A

Start at a low dose
Dose to body surface area
Never use loading dose
Always check serum levels after 7 days

If ventricular rate is still to high add in another drug - eg: diltiazem for AF

41
Q

What is the optimal treatment for CHF?

A 
Furosemide
Benazepril / ace inhibitor 
Pimobendan 
Spironolactone 
(SPAF)
42
Q

Which anti-arrhythmic drug should you use to treat ventricular tachycardia long term?

A

Mexiletine

Class 1b anti-arrhythmic - Na+ channel inhibitor

43
Q

Which drugs should you combine to achieve the best control in atrial fibrillation?

A

Treat underlying CHF - due to atrial stretch in small animals

Digoxin and diltiazem = chemical cardioversion
+/- Beta blockers (never in CHF)

44
Q

How should you treat sick sinus syndrome?

A

Propantheline, pheylpropylamine

= parasympatheticolyics

45
Q

How can ventricular tachycardia be treated?

A

First - Lidocaine IV then CRI - class 1b

Esmolol / Sotalol (beta blocker - class 2 anti-arrhythmic)
- Sotalol also has class 3 actions 
Mexilitine (Na channel blocker - class 1 anti-arrhythmic) 
Amiodarone (class 1, 2 and 3 (K+ channel blocker) actions)
46
Q

How should you treat supra ventricular tachycardia caused by high vagal tone?

A

Vagal manoeuvres
Verapamil / Diltiazem (Ca2+ channel blocker)
Esmolol (beta blocker)

47
Q

How should you treat supraventricular arrhythmias?

A 
Diltiazem - class 4 anti-arrhythmic - calcium channel blocker
Digoxin - class 5 anti-arrhythmic - cardiac glycoside
48
Q

How should you treat pulmonary hypertension?

A

Slidenafil - PDE inhibitor - vasodilator
Pimobendan - PDE inhibitor - venodilator
Anti coagulation therapy

49
Q

What nutraceuticals and dietary modifications can you make in CHF?

A

Omega 3
Taurine - cats with DCM
Reduce Na+ in diet

50
Q

How can you suppress a cough?

A

Opioids - codeine and butorphanol

51
Q

What is a beneficial drug in pre-clinical mitral valve disease?

A

Pimobendan

Can delay onset of CHF by 15 months

52
Q

What is the action of class 1 anti-arrhythmic?

A

Block Na+ channels

1a (intermediate Na+ channel blockers) - quinidine
1b (fast Na+ channel blockers) - lidocaine, mexilitine
1c (slow Na+ channel blockers) - encainide

53
Q

What are class 2 anti-arrhythmics?

A

Beta blockers

Propanolol, Esmolol, atenolol, Sotalol (but mostly class 3)

54
Q

What are class 3 anti-arrhythmias?

A

K+ channel blockers

Amoiodarone - also has class 1 and 2 actions
Sotalol - also a beta blocker class 2
55
Q

What are class 4 anti-arrhythmic drugs?

A

Calcium channel blockers

Diltiazem
Verapamil

56
Q

What are class 5 anti-arrhythmics?

A

Direct nodal inhibition

Digoxin
Adenosine

57
Q

How should you treat preclinical HCM?

A

Beta blockers - atenolol, Propanolol, emsomolol

  • reduce LVOT and SAM
  • slows heart rate and improves diastolic function
  • CI in CHF

Pimobendan - Ca channel blocker
Benazepril - ace inhibitor
Diltiazem - positive lusiotrope = improves diastolic filling

There is no evidence that any drug slows down the progression to CHF

58
Q

How should you treat clinical HCM?

A

Furosemide
Benazepril
Clopidogrel and aspirin

59
Q

How should you manage a case of dysponea due to life threatening oedema in a cat?

A

Oxygen cage in a darkened room
Administer furosemide IV if a catheter can be placed, if not IM
Sedation with methadone if very anxious
Drain pleural effusion

60
Q

How can you screen for HCM?

A

Annual screening by echo in breeding cats

Pro BNP on blood or pleural effusion in CHF cases only

61
Q

How should you manage feline DCM?

A 
Furosemide
Benazepril
Pimobendan 
Digoxin 
Taurine

Warmth
Humorous oxygen
Drain pleural effusion

62
Q

How should you treat feline aortic thromboembolism?

A 
Methadone - pain
Aspirin
Clopidogrel 
Low molecular weight heparin
Physio

Treatment for CHF: Spironolactone, Benazepril, Pimobendan, furosemide

63
Q

What drug is particularly useful in HOCM? When there is a left ventricular outflow tract obstruction

A

Atenolol - decreases heart rate and increases diastolic filling time

64
Q

Diltiazem

A

Class 4 anti-arrhythmic
Calcium channel blocker

Negative chronotrope - achieves best rate control on AF with digoxin

Works quicker than digoxin which takes around a week to work

65
Q

When are beta blockers contraindicated?

A

Uncontrolled CHF
- sympathetic tone is maintaining cardiac output

Diltiazem acts quicker in AF and is well tolerated

66
Q

How can you treat supraventricular tachycardia due to an accessory pathway? (Wolff-Parkinson-White syndrome)

A

Ablate accessory pathway

Identified by delta waves on the ECG, notched QRS

67
Q

What criteria should you use to decide to treat ventricular tachycardia?

A

Multiform
Patient haemodynamically compromised
HR rate over 200
R on T phenomemnon - high risk of progressing to V fib

68
Q

What should you give only if IV lidocaine does not resolve ventricular tachycardia?

A

IV Amiodarone

Need to premedicate with steroids and anti-histamines first

69
Q

How should you treat a bradyarrhythmia?

A

Rule out Hyperkalaemia / hypothyroidism
Atropine response test - if vagally mediated, HR will double in 30-40 mins

Anti-cholinergics - atropine, propantheline

Beta agonists - terbutaline (beta 2)

Xanthine derivatives - theophylline, aminothylline, etamiphyline

Pacemaker

70
Q

How should you initially treat hypertension?

A

Amlodipine - calcium channel blocker with just vascular effects

71
Q

How can you protect the kidneys in hypertension?

A

Ace inhibitors - benazepril
- reduce the GFR

Angiotensin II receptor blockers - Telmisartan

72
Q

How can you prevent FATE in cats?

A

Low dose aspirin
Clopidogrel - FAT cat study - more effective at prevention
Low molecular weight Heparin (don’t need to monitor clotting time)

73
Q

How should you treat pulmonary thromboembolism?

A

O2 therapy
Clopidogrel
Aspirin
Low molecular weight heparin

74
Q

How should you treat lungworm?

A

Fenbendazole (panacur)
Milbemycin oxime (Milbemax)
Moxidectin (with imidacloprid in advocate) - repeat in 30days

Prednisolone - if pulmonary haemorrhage or very severe burden

75
Q

How can you prevent lungworm?

A

Moxidectin or milbemycin q 4w

Small Animal Cardiology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions