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Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

primary use of diuretics

A

treat congestive heart failure

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2
Q

primary stimuli for aldosterone

A

angiotensin II, hyperkalemia

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3
Q

aldosterone hormone type

A

steroid

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4
Q

osmotic diuretic mechanism of action in body

A

increase plasma volume, increase renal blood flow

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5
Q

osmotic diuretics mechanism of action in kidney

A

increase osmolality within tubule, prevent passive water reabsorption

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6
Q

examples of osmotic diuretics

A

mannitol, glycerol

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7
Q

mannitol contraindication

A

CHF

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8
Q

glycerol contraindication

A

diabetes mellitus

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9
Q

carbonic anhydrase inhibitors increase excretion of

A

bicarbonate, sodium, potassium, water

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10
Q

carbonic anhydrase inhibitor examples

A

acetazolamide, dorzolamide

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11
Q

loop diuretic mechanism of action

A

inhibit Na/K/Cl cosymporter

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12
Q

loop diuretics adverse effects

A

depletion of Na, K, Cl, dehydration, hypovolemia, azotemia

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13
Q

loop diuretic examples

A

furosemide, torsemide

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14
Q

furosemide IV

A

onset 5-10 min; peak effect 30 min; duration of effect 2-3 hrs

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15
Q

furosemide PO

A

onset 1 hr; peak effect 1-2 hrs; duration 6 hrs

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16
Q

torsemide given

A

PO

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17
Q

torsemide advantage

A

longer effect

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18
Q

chronic CHF treatment

A

2 mg/kg PO BID furosemide

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19
Q

acute CHF treatment

A

2 mg/kg bolus, repeat bolus or CRI furosemide

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20
Q

thiazide diuretic mechanism

A

inhibits Na/Cl symporter

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21
Q

thiazide indication

A

refractory CHF

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22
Q

adverse effects of thiazides

A

hyponatremia, hypochloremia, dehydration, hypovolemia, azotemia

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23
Q

example of thiazide

A

hydrochlorothiazide

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24
Q

potassium-sparing diuretics mechanisms

A

spironolactone: aldosterone antagonist;
triamterene, amiloride: blocks Na channels

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25
Q

potassium-sparing diuretics effect

A

increase excretion of sodium (and water), reduce excretion of K, H+, Ca, Mg

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26
Q

spironolactone diuretic effect

A

weak

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27
Q

spironolactone use in CHF

A

combat hypokalemia, help inhibit RAAS, anti-fibrotic

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28
Q

spironolactone dose

A

1-2 mg/kg PO SID-BID

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29
Q

spironolactone contraindications

A

hyperkalemia, facial excoriations; rare

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30
Q

aquaretics mechanism of action

A

block ADH V2 receptor, prevent insertion of aquaporins

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31
Q

aquaretics effect on water

A

promote excretion with little to no sodium loss

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32
Q

aquaretic indications

A

syndrome of inappropriate ADH secretion, hyponatremic CHF

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33
Q

aquaretic suffix

A

-vaptan

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34
Q

natriuretic peptides

A

endogenous hormones; BNP, ANP

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35
Q

natriuretic peptides effect

A

promote natriuresis and diuresis

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36
Q

natriuretic peptide use

A

biomarker

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37
Q

natriuretic peptide mechanism of action

A

inhibit Na transport, decrease Na/Cl reabsorption

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38
Q

carbonic anhydrase effects outside kidney

A

metabolic acidosis, decreased production of ciliary aqueous humor

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39
Q

vasodilators used for

A

CHF, systemic and pulmonary hypertension

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40
Q

vascular smM contraction influx of

A

calcium

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41
Q

vascular smM relaxation influx of

A

nitric oxide

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42
Q

vascular beds affected by drugs

A

systemic arteriolar, pulmonary arteriolar, venous, arteriolar and venous smM

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43
Q

heart failure effect on preload and afterload

A

increase both

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44
Q

goals of heart failure treatment

A

alleviate congestion, improve forward flow, reduce neuroendocrine response

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45
Q

preload reducers

A

diuretics, nitroglycerin, isosorbide dinitrate/mononitrate

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46
Q

nitroglycerin effect on vessels

A

venodilator

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47
Q

nitroglycerin overall effects

A

increase venous capacitance, redistribute blood away from heart

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48
Q

nitroglycerin action

A

denitrates and generates NO, relax smM

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49
Q

nitroglycerin formulations

A

ointment, tablets (low bioavailability), injectable

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50
Q

nitroglycerin tolerance

A

at site, systemic by 18-24 hrs

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51
Q

nitroglycerin indication

A

adjunctive therapy for CHF

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52
Q

isosorbide nitrates

A

same mechanism and indications as nitroglycerin

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53
Q

nitroprusside vascular effect

A

veno and arteriolar dilator

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54
Q

nitroprusside action

A

generates NO in circulation

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55
Q

nitroprusside indications

A

hypertensive crisis, adjunctive for severe CHF

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56
Q

monitor ____ while administering nitroprusside

A

BP

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57
Q

metabolites of nitroprusside

A

NO, methemoglobin, cyanogen

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58
Q

nitroprusside adverse effects

A

profound hypotension, cyanide toxicity, thiocyanate toxicity

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59
Q

nitroprusside length of use

A

short term

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60
Q

hydralazine vascular effect

A

arteriolar dilator

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61
Q

hydralazine action

A

?

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62
Q

hydralazine PK

A

quick onset, duration 12 hrs

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63
Q

hydralazine indication

A

systemic hypertension, adjunctive for CHF

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64
Q

hydralazine adverse effects

A

hypotension, GI upset, reflex tachycardia

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65
Q

amlodipine action

A

calcium channel blocker, arteriolar vasodilator

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66
Q

amlodipine PK

A

good bioavailability, slow onset

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67
Q

amlodipine indications

A

systemic hypertension, adjunctive of CHF

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68
Q

amlodipine adverse effects

A

gingival hyperplasia, hypotension

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69
Q

amlodipine treatment of choice for

A

feline systemic hypertension

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70
Q

pimobendan action

A

inodilator: positive inotrope via Ca sensitization, balanced vasodilation by PDE3 inhibition

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71
Q

normal BP

A

120/80

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72
Q

normal pulmonary pressures

A

25/10

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73
Q

endothelin receptor antagonist

A

bosentan

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74
Q

prostacyclin analogs

A

epoprostenol, treprostinil, iloprost

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75
Q

endothelin and prostacyclin drugs used in vet med

A

false

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76
Q

nitric oxide pathway: PDE5 inhibitor drugs

A

sildenafil, tadalafil

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77
Q

indications for PDE5 inhibitors

A

pulmonary hypertension

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78
Q

PDE5 location

A

lungs

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79
Q

ACE inhibitor examples

A

enalapril, benazapril

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80
Q

active metabolite of enalapril

A

enalaprilat

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81
Q

enalapril primary excretion

A

renal

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82
Q

benazapril excretion

A

biliary and renal

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83
Q

ace inhibitor indications

A

chronic CHF, occult DCM, degenerative mitral valve disease, renal proteinuria, systemic hypertension

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84
Q

ACE inhibitor adverse effects

A

azotemia, coughing

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85
Q

angiotensin receptor blockers indications

A

adverse reaction to inhibitors, inadequate response, systemic hypertension, alternative treatment for renal proteinuria

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86
Q

angiotensin receptor blockers

A

telmisartan, losartan, valsartan

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87
Q

angiotensin receptor blocker action

A

block AT1 receptor

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88
Q

entresto

A

sacubitril (reduce breakdown of natriuretic peptids), valsartan (ARB)

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89
Q

group 1 pulmonary hypertension

A

primary; congenital L-R shunt

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90
Q

group 2 pulmonary hypertension

A

left-sided heart disease; valve disease, cardiomyopathy

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91
Q

group 3 pulmonary hypertension

A

lung disease; COPD, interstitial

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92
Q

group 4 pulmonary hypertension

A

pulmonary thromboembolism

93
Q

group 5 pulmonary hypertension

A

miscellaneous; parasites

94
Q

cells with automaticity in heart

A

SA node and AV node

95
Q

depolarization phases of pacemaker cells

A

phase 0 and 4

96
Q

repolarization phase of pacemaker cells

A

phase 3

97
Q

funny current open when

A

hyperpolarized

98
Q

funny current channel type

A

non-specific cation, allow slow Na influx

99
Q

phase 0 depolarization (pacemaker) due to

A

voltage sensitive Ca channels

100
Q

phase 3 repolarization (pacemaker) due to

A

closure of influx channels, efflux of K

101
Q

phase 4 (non-pacemaker) maintained by

A

Na/K pump

102
Q

phase 0 (non-pacemaker) channels

A

fast Na channels

103
Q

phase 1 (non-pacemaker) channels

A

inactivate Na channels, activation of K channels

104
Q

phase 2 (non-pacemaker) channels

A

activation of Ca channels, inactivation of K, activation of slow K channels

105
Q

phase 3 (non-pacemaker) channels

A

inactivation of Ca, continued K efflux

106
Q

mechanisms of arrhythmia formation

A

abnormal impulse formation or conduction, or both

107
Q

abnormal impulse formation mechanisms

A

abnormal/enhanced automaticity, triggered activity

108
Q

enhanced automaticity caused by

A

altered autonomic tone

109
Q

abnormal automaticity caused by

A

ischemia, acid/base imbalance, electrolyte derangements

110
Q

abnormal automaticity resting membrane

A

increase (-90 to -60)

111
Q

triggered activity

A

afterdepolarization

112
Q

afterdepolarization due to

A

Na or Ca influx

113
Q

afterdepolarization can cause AP

A

true

114
Q

early afterdepolarization caused by

A

acidemia, hypoxia, QT prolonging drugs, catecholamines

115
Q

delayed afterdepolarization caused by

A

myocardial infarction, catecholamines, digitalis glycosides

116
Q

types of abnormal impulse conduction

A

conduction blocks, re-entrant activation

117
Q

causes of conduction block

A

ischemia, fibrosis, high vagal tone, negative dromotropic agents (at important sites)

118
Q

causes of re-entrant activation

A

unidirectional block, area of slow conduction; ischemia, fibrosis, infiltration

119
Q

goal of anti-arrhythmic therapy

A

restore sinus rhythm, reduce frequency/complexity of arrythmias, reduce mortality

120
Q

Class I anti-arrhythmics

A

Na channel blockers

121
Q

Class II anti-arrhythmics

A

beta blockers

122
Q

Class III anti-arrhythmics

A

K channel blockers

123
Q

Class IV anti-arrhythmics

A

Ca channel antagonists

124
Q

Class I anti-arrhythmics effect on AP

A

slow upstroke

125
Q

Class I subclasses defined by

A

effects on K efflux

126
Q

Class Ia examples

A

quinidine, procainamide

127
Q

Class Ia effects on AP

A

depress upstroke, prolong repolarization

128
Q

Class Ia other effects

A

anti-cholinergic

129
Q

avoid class _____ drugs with class Ia

A

III

130
Q

Class Ia risk

A

torsade de pointes

131
Q

other effects of quinidine

A

anti-cholinergic, alpha-adrenergic blocking

132
Q

indications for quinidine

A

ventricular and supraventricular tachyarrhythmias in dogs, atrial fibrillation in horses

133
Q

effect of K on quinidine

A

hypokalemia reduces effects, hyperkalemia increases effects

134
Q

quinidine administration (horses)

A

NG tube, IV

135
Q

quinidine adverse effects

A

GI upset, hypotension, cardiac toxicity

136
Q

cardiac toxicity of quinidine

A

increase QT interval and QRS

137
Q

drug interactions of quinidine

A

digoxin; competition at skeletal muscle, more quinidine available

138
Q

indications for procainamide

A

supraventricular and ventricular tachycardia (after lidocaine)

139
Q

adverse effects of procainamide

A

GI upset, hypotension

140
Q

Class Ib examples

A

lidocaine/mexiletine

141
Q

Class Ib action

A

depress upstroke, accelerates repolarization

142
Q

class Ib drug of choice for

A

ventricular tachycardia

143
Q

lidocaine half life

A

short, extensive first pass metabolism

144
Q

lidocaine dose dog

A

2 mg/kg IV (can repeat 4 times in 20-30 min)

145
Q

lidocaine CRI dog

A

25-100 mcg/kg/min

146
Q

mexiletine

A

oral lidocaine

147
Q

indications for mexiletine

A

chronic therapy for ventricular arrhythmias

148
Q

mexiletine dose interval

A

q8hrs

149
Q

Class Ic examples

A

encainide, flecainide

150
Q

Class Ic indication

A

none

151
Q

Class II examples

A

esmolol, propanolol, atenolol

152
Q

Class II indications

A

ventricular and supraventricular arrhythmias, anti-ischemia

153
Q

Class II drugs decrease

A

cAMP arrhythmias and Ca activity, rate of spontaneous diastolic depolarization

154
Q

beta 1 blockade

A

reduce contractility, reduce spontaneous depolarization at nodes, slow conduction through AV node

155
Q

chronic catecholamine stimulation results in

A

beta receptor downregulation

156
Q

some CHF patients may require _____ to maintain contractility

A

beta receptor stimulation

157
Q

Class II adverse effects

A

bronchospasm, bradyarrhythmias, precipitate CHF

158
Q

Class II contraindications

A

primary pulmonary disease, bradyarrhythmias, uncontrolled CHF, myocardial systolic dysfunction

159
Q

esmolol

A

beta 1, ultra short acting, emergent/short term IV therapy

160
Q

propanolol

A

non-selective, q8

161
Q

atenolol

A

beta 1, better bioavailability, q12

162
Q

Class III effect on action potential

A

delay and prolong repolarization

163
Q

amiodarone PK

A

high iodine content, long half life (req loading dose)

164
Q

amiodarone mechanism

A

blocks K (also Na, Ca)

165
Q

amiodarone concentrates in

A

heart, liver, lungs

166
Q

amiodarone indications

A

supraventricular and ventricular tachyarrhythmias, limited use in vet med

167
Q

amiodarone side effects

A

increase liver enzymes, pulmonary inflammation, thyroid dysfunction, anaphylaxis (solvents)

168
Q

sotalol mechanism

A

prolongs effective refractory period, weak beta blocker

169
Q

sotalol PK

A

rapid absorption, high bioavailability

170
Q

sotalol indications

A

ventricular tachycardia (boxer cardiomyopathy), supraventricular tachycardia

171
Q

sotalol side effects

A

QT prolongation, other beta blocker side effects

172
Q

sotalol drug contraindications

A

class Ia

173
Q

class IV mechanisms

A

non-dihydropyridine Ca channel blocker, block L-type Ca channel

174
Q

class IV indications

A

supraventricular tachyarrhythmias, reduce MVO2

175
Q

class IV adverse effects

A

bradyarrhythmias, precipitate CHF, hypotension

176
Q

class IV drug concern

A

concurrent beta blocker

177
Q

diltiazem cardiac effects

A

negative dromotropic, chronotropic, and inotropic

178
Q

diltiazem PK

A

rapid absorption, short half life (q8)

179
Q

diltiazem indications

A

supraventricular arrhythmias only

180
Q

verapamil

A

equal heart and vascular effects, negative dromotropic and chronotropic, vasodilation

181
Q

verapamil indication

A

acute management of supraventricular arrhythmias

182
Q

digoxin indication

A

supraventricular arrhythmias

183
Q

digoxin effects

A

positive inotrope, re-sensitizes baroreceptors

184
Q

adenosine use

A

not used in dogs

185
Q

ivabradine mechanism

A

selective inhibition of funny current

186
Q

ivabradine effect

A

reduce SA node activity, negative chronotrope only

187
Q

magnesium

A

physiologic Ca blocker, required for Na/K function

188
Q

magnesium indications

A

refractory ventricular tachyarrhythmias

189
Q

atropine and glycopyrrolate indications

A

bradyarrhythmias

190
Q

sympathomimetics indications

A

bradyarrhythmias

191
Q

methylxanthine derivative indication

A

bradyarrhythmias

192
Q

methylxanthine derivative examples

A

theophylline, aminophylline

193
Q

methylxanthine derivative mechanism

A

nonselective PDE inhibitor

194
Q

methylxanthine derivative effects

A

increase HR and bronchodilation

195
Q

supraventricular treatment (Atrial tachyarrhythmia)

A

B: beta blockers
C: calcium channel blockers
D: digoxin

196
Q

ventricular tachycardia treatment

A
  1. lidocaine
    other: procainamide, esmolol, Mg, nexterone, electrical
197
Q

chronic ventricular arrhythmia treatment

A

S: sotalol
P: procainamide or propanolol
A: atenolol or amiodarone
M: mexiletine

198
Q

chronic ventricular arrhythmia treatment classes

A

Na channel blockers, beta blockers, K channel blockers

199
Q

mechanisms of increasing myocardial contractility

A

mobilize more calcium, increase sensitivity to calcium

200
Q

cardiac glycoside inotropy mechanism

A

positive, mobilize calcium

201
Q

cardiac glycoside chronotropy

A

negative

202
Q

groups of cardiac glycosides

A

plant cardenolides and bufadienolide

203
Q

effects of digoxin

A

weak positive inotrope, baroreceptor modulation, anti-arrhythmic

204
Q

digoxin mechanism

A

inhibit Na/K pump; reversal, Na pumped out and Ca in; increases PSNS tone at baroreceptor

205
Q

digoxin effect on ANS

A

increase PSNS, decrease SNS

206
Q

digoxin dromotropy

A

negative

207
Q

primary use of digoxin

A

supraventricular arrhythmias

208
Q

digoxin not used for

A

systolic dysfunction, CHF

209
Q

digoxin drug interactions

A

lots

210
Q

digoxin therapeutic range, half-life

A

narrow, long (30hrs)

211
Q

digoxin side effect systems

A

neurologic, GI, cardiac

212
Q

digoxin neuro side effects

A

lethargy, depression

213
Q

digoxin GI side effects

A

anorexia, hyporexia, vomiting

214
Q

digoxin cardiac side effects

A

ventricular arrhythmias, bradyarrhythmias

215
Q

digoxin toxicity treatment

A

pause drug, antibody fragment, temporary cardiac pacing

216
Q

sympathomimetic amines, positive inotropes

A

dopamine and dobutamine

217
Q

sympathomimetic amines mechanism

A

activate adenylyl cyclase, calcium mobilizers

218
Q

positive inotrope dosing of dopamine

A

moderate dose (beta 1 stimulation)

219
Q

positive chronotrope dosing of dobutamine

A

high doses

220
Q

sympathomimetic amine use

A

IV only, short half-life

221
Q

inodilator effects

A

postive inotropic and vasodilatory

222
Q

inodilator example

A

pimobendan

223
Q

inodilator inotropy mechanism

A

calcium sensitization

224
Q

inodilatory vasodilatory mechanism

A

PDE3 inhibitor, minor

225
Q

pimobendan administration

A

PO

226
Q

inodilator indications

A

degenerative valve disease, DCM, other disease

227
Q

inodilator use in degenerative valve disease/DCM

A

delay onset of CHF, treat CHF

228
Q

pimobendan side effects

A

rare; usually GI, lethargy

229
Q

pimobendan use in cats

A

maybe use in CHF in HCM

Pharmacology (7 decks)

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