Cardiovascular Flashcards
1
Q
primary use of diuretics
A
treat congestive heart failure
2
Q
primary stimuli for aldosterone
A
angiotensin II, hyperkalemia
3
Q
aldosterone hormone type
A
steroid
4
Q
osmotic diuretic mechanism of action in body
A
increase plasma volume, increase renal blood flow
5
Q
osmotic diuretics mechanism of action in kidney
A
increase osmolality within tubule, prevent passive water reabsorption
6
Q
examples of osmotic diuretics
A
mannitol, glycerol
7
Q
mannitol contraindication
A
CHF
8
Q
glycerol contraindication
A
diabetes mellitus
9
Q
carbonic anhydrase inhibitors increase excretion of
A
bicarbonate, sodium, potassium, water
10
Q
carbonic anhydrase inhibitor examples
A
acetazolamide, dorzolamide
11
Q
loop diuretic mechanism of action
A
inhibit Na/K/Cl cosymporter
12
Q
loop diuretics adverse effects
A
depletion of Na, K, Cl, dehydration, hypovolemia, azotemia
13
Q
loop diuretic examples
A
furosemide, torsemide
14
Q
furosemide IV
A
onset 5-10 min; peak effect 30 min; duration of effect 2-3 hrs
15
Q
furosemide PO
A
onset 1 hr; peak effect 1-2 hrs; duration 6 hrs
16
Q
torsemide given
A
PO
17
Q
torsemide advantage
A
longer effect
18
Q
chronic CHF treatment
A
2 mg/kg PO BID furosemide
19
Q
acute CHF treatment
A
2 mg/kg bolus, repeat bolus or CRI furosemide
20
Q
thiazide diuretic mechanism
A
inhibits Na/Cl symporter
21
Q
thiazide indication
A
refractory CHF
22
Q
adverse effects of thiazides
A
hyponatremia, hypochloremia, dehydration, hypovolemia, azotemia
23
Q
example of thiazide
A
hydrochlorothiazide
24
Q
potassium-sparing diuretics mechanisms
A
spironolactone: aldosterone antagonist;
triamterene, amiloride: blocks Na channels
25
potassium-sparing diuretics effect
increase excretion of sodium (and water), reduce excretion of K, H+, Ca, Mg
26
spironolactone diuretic effect
weak
27
spironolactone use in CHF
combat hypokalemia, help inhibit RAAS, anti-fibrotic
28
spironolactone dose
1-2 mg/kg PO SID-BID
29
spironolactone contraindications
hyperkalemia, facial excoriations; rare
30
aquaretics mechanism of action
block ADH V2 receptor, prevent insertion of aquaporins
31
aquaretics effect on water
promote excretion with little to no sodium loss
32
aquaretic indications
syndrome of inappropriate ADH secretion, hyponatremic CHF
33
aquaretic suffix
-vaptan
34
natriuretic peptides
endogenous hormones; BNP, ANP
35
natriuretic peptides effect
promote natriuresis and diuresis
36
natriuretic peptide use
biomarker
37
natriuretic peptide mechanism of action
inhibit Na transport, decrease Na/Cl reabsorption
38
carbonic anhydrase effects outside kidney
metabolic acidosis, decreased production of ciliary aqueous humor
39
vasodilators used for
CHF, systemic and pulmonary hypertension
40
vascular smM contraction influx of
calcium
41
vascular smM relaxation influx of
nitric oxide
42
vascular beds affected by drugs
systemic arteriolar, pulmonary arteriolar, venous, arteriolar and venous smM
43
heart failure effect on preload and afterload
increase both
44
goals of heart failure treatment
alleviate congestion, improve forward flow, reduce neuroendocrine response
45
preload reducers
diuretics, nitroglycerin, isosorbide dinitrate/mononitrate
46
nitroglycerin effect on vessels
venodilator
47
nitroglycerin overall effects
increase venous capacitance, redistribute blood away from heart
48
nitroglycerin action
denitrates and generates NO, relax smM
49
nitroglycerin formulations
ointment, tablets (low bioavailability), injectable
50
nitroglycerin tolerance
at site, systemic by 18-24 hrs
51
nitroglycerin indication
adjunctive therapy for CHF
52
isosorbide nitrates
same mechanism and indications as nitroglycerin
53
nitroprusside vascular effect
veno and arteriolar dilator
54
nitroprusside action
generates NO in circulation
55
nitroprusside indications
hypertensive crisis, adjunctive for severe CHF
56
monitor ____ while administering nitroprusside
BP
57
metabolites of nitroprusside
NO, methemoglobin, cyanogen
58
nitroprusside adverse effects
profound hypotension, cyanide toxicity, thiocyanate toxicity
59
nitroprusside length of use
short term
60
hydralazine vascular effect
arteriolar dilator
61
hydralazine action
?
62
hydralazine PK
quick onset, duration 12 hrs
63
hydralazine indication
systemic hypertension, adjunctive for CHF
64
hydralazine adverse effects
hypotension, GI upset, reflex tachycardia
65
amlodipine action
calcium channel blocker, arteriolar vasodilator
66
amlodipine PK
good bioavailability, slow onset
67
amlodipine indications
systemic hypertension, adjunctive of CHF
68
amlodipine adverse effects
gingival hyperplasia, hypotension
69
amlodipine treatment of choice for
feline systemic hypertension
70
pimobendan action
inodilator: positive inotrope via Ca sensitization, balanced vasodilation by PDE3 inhibition
71
normal BP
120/80
72
normal pulmonary pressures
25/10
73
endothelin receptor antagonist
bosentan
74
prostacyclin analogs
epoprostenol, treprostinil, iloprost
75
endothelin and prostacyclin drugs used in vet med
false
76
nitric oxide pathway: PDE5 inhibitor drugs
sildenafil, tadalafil
77
indications for PDE5 inhibitors
pulmonary hypertension
78
PDE5 location
lungs
79
ACE inhibitor examples
enalapril, benazapril
80
active metabolite of enalapril
enalaprilat
81
enalapril primary excretion
renal
82
benazapril excretion
biliary and renal
83
ace inhibitor indications
chronic CHF, occult DCM, degenerative mitral valve disease, renal proteinuria, systemic hypertension
84
ACE inhibitor adverse effects
azotemia, coughing
85
angiotensin receptor blockers indications
adverse reaction to inhibitors, inadequate response, systemic hypertension, alternative treatment for renal proteinuria
86
angiotensin receptor blockers
telmisartan, losartan, valsartan
87
angiotensin receptor blocker action
block AT1 receptor
88
entresto
sacubitril (reduce breakdown of natriuretic peptids), valsartan (ARB)
89
group 1 pulmonary hypertension
primary; congenital L-R shunt
90
group 2 pulmonary hypertension
left-sided heart disease; valve disease, cardiomyopathy
91
group 3 pulmonary hypertension
lung disease; COPD, interstitial
92
group 4 pulmonary hypertension
pulmonary thromboembolism
93
group 5 pulmonary hypertension
miscellaneous; parasites
94
cells with automaticity in heart
SA node and AV node
95
depolarization phases of pacemaker cells
phase 0 and 4
96
repolarization phase of pacemaker cells
phase 3
97
funny current open when
hyperpolarized
98
funny current channel type
non-specific cation, allow slow Na influx
99
phase 0 depolarization (pacemaker) due to
voltage sensitive Ca channels
100
phase 3 repolarization (pacemaker) due to
closure of influx channels, efflux of K
101
phase 4 (non-pacemaker) maintained by
Na/K pump
102
phase 0 (non-pacemaker) channels
fast Na channels
103
phase 1 (non-pacemaker) channels
inactivate Na channels, activation of K channels
104
phase 2 (non-pacemaker) channels
activation of Ca channels, inactivation of K, activation of slow K channels
105
phase 3 (non-pacemaker) channels
inactivation of Ca, continued K efflux
106
mechanisms of arrhythmia formation
abnormal impulse formation or conduction, or both
107
abnormal impulse formation mechanisms
abnormal/enhanced automaticity, triggered activity
108
enhanced automaticity caused by
altered autonomic tone
109
abnormal automaticity caused by
ischemia, acid/base imbalance, electrolyte derangements
110
abnormal automaticity resting membrane
increase (-90 to -60)
111
triggered activity
afterdepolarization
112
afterdepolarization due to
Na or Ca influx
113
afterdepolarization can cause AP
true
114
early afterdepolarization caused by
acidemia, hypoxia, QT prolonging drugs, catecholamines
115
delayed afterdepolarization caused by
myocardial infarction, catecholamines, digitalis glycosides
116
types of abnormal impulse conduction
conduction blocks, re-entrant activation
117
causes of conduction block
ischemia, fibrosis, high vagal tone, negative dromotropic agents (at important sites)
118
causes of re-entrant activation
unidirectional block, area of slow conduction; ischemia, fibrosis, infiltration
119
goal of anti-arrhythmic therapy
restore sinus rhythm, reduce frequency/complexity of arrythmias, reduce mortality
120
Class I anti-arrhythmics
Na channel blockers
121
Class II anti-arrhythmics
beta blockers
122
Class III anti-arrhythmics
K channel blockers
123
Class IV anti-arrhythmics
Ca channel antagonists
124
Class I anti-arrhythmics effect on AP
slow upstroke
125
Class I subclasses defined by
effects on K efflux
126
Class Ia examples
quinidine, procainamide
127
Class Ia effects on AP
depress upstroke, prolong repolarization
128
Class Ia other effects
anti-cholinergic
129
avoid class _____ drugs with class Ia
III
130
Class Ia risk
torsade de pointes
131
other effects of quinidine
anti-cholinergic, alpha-adrenergic blocking
132
indications for quinidine
ventricular and supraventricular tachyarrhythmias in dogs, atrial fibrillation in horses
133
effect of K on quinidine
hypokalemia reduces effects, hyperkalemia increases effects
134
quinidine administration (horses)
NG tube, IV
135
quinidine adverse effects
GI upset, hypotension, cardiac toxicity
136
cardiac toxicity of quinidine
increase QT interval and QRS
137
drug interactions of quinidine
digoxin; competition at skeletal muscle, more quinidine available
138
indications for procainamide
supraventricular and ventricular tachycardia (after lidocaine)
139
adverse effects of procainamide
GI upset, hypotension
140
Class Ib examples
lidocaine/mexiletine
141
Class Ib action
depress upstroke, accelerates repolarization
142
class Ib drug of choice for
ventricular tachycardia
143
lidocaine half life
short, extensive first pass metabolism
144
lidocaine dose dog
2 mg/kg IV (can repeat 4 times in 20-30 min)
145
lidocaine CRI dog
25-100 mcg/kg/min
146
mexiletine
oral lidocaine
147
indications for mexiletine
chronic therapy for ventricular arrhythmias
148
mexiletine dose interval
q8hrs
149
Class Ic examples
encainide, flecainide
150
Class Ic indication
none
151
Class II examples
esmolol, propanolol, atenolol
152
Class II indications
ventricular and supraventricular arrhythmias, anti-ischemia
153
Class II drugs decrease
cAMP arrhythmias and Ca activity, rate of spontaneous diastolic depolarization
154
beta 1 blockade
reduce contractility, reduce spontaneous depolarization at nodes, slow conduction through AV node
155
chronic catecholamine stimulation results in
beta receptor downregulation
156
some CHF patients may require _____ to maintain contractility
beta receptor stimulation
157
Class II adverse effects
bronchospasm, bradyarrhythmias, precipitate CHF
158
Class II contraindications
primary pulmonary disease, bradyarrhythmias, uncontrolled CHF, myocardial systolic dysfunction
159
esmolol
beta 1, ultra short acting, emergent/short term IV therapy
160
propanolol
non-selective, q8
161
atenolol
beta 1, better bioavailability, q12
162
Class III effect on action potential
delay and prolong repolarization
163
amiodarone PK
high iodine content, long half life (req loading dose)
164
amiodarone mechanism
blocks K (also Na, Ca)
165
amiodarone concentrates in
heart, liver, lungs
166
amiodarone indications
supraventricular and ventricular tachyarrhythmias, limited use in vet med
167
amiodarone side effects
increase liver enzymes, pulmonary inflammation, thyroid dysfunction, anaphylaxis (solvents)
168
sotalol mechanism
prolongs effective refractory period, weak beta blocker
169
sotalol PK
rapid absorption, high bioavailability
170
sotalol indications
ventricular tachycardia (boxer cardiomyopathy), supraventricular tachycardia
171
sotalol side effects
QT prolongation, other beta blocker side effects
172
sotalol drug contraindications
class Ia
173
class IV mechanisms
non-dihydropyridine Ca channel blocker, block L-type Ca channel
174
class IV indications
supraventricular tachyarrhythmias, reduce MVO2
175
class IV adverse effects
bradyarrhythmias, precipitate CHF, hypotension
176
class IV drug concern
concurrent beta blocker
177
diltiazem cardiac effects
negative dromotropic, chronotropic, and inotropic
178
diltiazem PK
rapid absorption, short half life (q8)
179
diltiazem indications
supraventricular arrhythmias only
180
verapamil
equal heart and vascular effects, negative dromotropic and chronotropic, vasodilation
181
verapamil indication
acute management of supraventricular arrhythmias
182
digoxin indication
supraventricular arrhythmias
183
digoxin effects
positive inotrope, re-sensitizes baroreceptors
184
adenosine use
not used in dogs
185
ivabradine mechanism
selective inhibition of funny current
186
ivabradine effect
reduce SA node activity, negative chronotrope only
187
magnesium
physiologic Ca blocker, required for Na/K function
188
magnesium indications
refractory ventricular tachyarrhythmias
189
atropine and glycopyrrolate indications
bradyarrhythmias
190
sympathomimetics indications
bradyarrhythmias
191
methylxanthine derivative indication
bradyarrhythmias
192
methylxanthine derivative examples
theophylline, aminophylline
193
methylxanthine derivative mechanism
nonselective PDE inhibitor
194
methylxanthine derivative effects
increase HR and bronchodilation
195
supraventricular treatment (Atrial tachyarrhythmia)
B: beta blockers
C: calcium channel blockers
D: digoxin
196
ventricular tachycardia treatment
1. lidocaine
other: procainamide, esmolol, Mg, nexterone, electrical
197
chronic ventricular arrhythmia treatment
S: sotalol
P: procainamide or propanolol
A: atenolol or amiodarone
M: mexiletine
198
chronic ventricular arrhythmia treatment classes
Na channel blockers, beta blockers, K channel blockers
199
mechanisms of increasing myocardial contractility
mobilize more calcium, increase sensitivity to calcium
200
cardiac glycoside inotropy mechanism
positive, mobilize calcium
201
cardiac glycoside chronotropy
negative
202
groups of cardiac glycosides
plant cardenolides and bufadienolide
203
effects of digoxin
weak positive inotrope, baroreceptor modulation, anti-arrhythmic
204
digoxin mechanism
inhibit Na/K pump; reversal, Na pumped out and Ca in; increases PSNS tone at baroreceptor
205
digoxin effect on ANS
increase PSNS, decrease SNS
206
digoxin dromotropy
negative
207
primary use of digoxin
supraventricular arrhythmias
208
digoxin not used for
systolic dysfunction, CHF
209
digoxin drug interactions
lots
210
digoxin therapeutic range, half-life
narrow, long (30hrs)
211
digoxin side effect systems
neurologic, GI, cardiac
212
digoxin neuro side effects
lethargy, depression
213
digoxin GI side effects
anorexia, hyporexia, vomiting
214
digoxin cardiac side effects
ventricular arrhythmias, bradyarrhythmias
215
digoxin toxicity treatment
pause drug, antibody fragment, temporary cardiac pacing
216
sympathomimetic amines, positive inotropes
dopamine and dobutamine
217
sympathomimetic amines mechanism
activate adenylyl cyclase, calcium mobilizers
218
positive inotrope dosing of dopamine
moderate dose (beta 1 stimulation)
219
positive chronotrope dosing of dobutamine
high doses
220
sympathomimetic amine use
IV only, short half-life
221
inodilator effects
postive inotropic and vasodilatory
222
inodilator example
pimobendan
223
inodilator inotropy mechanism
calcium sensitization
224
inodilatory vasodilatory mechanism
PDE3 inhibitor, minor
225
pimobendan administration
PO
226
inodilator indications
degenerative valve disease, DCM, other disease
227
inodilator use in degenerative valve disease/DCM
delay onset of CHF, treat CHF
228
pimobendan side effects
rare; usually GI, lethargy
229
pimobendan use in cats
maybe use in CHF in HCM
