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3. Clin Pharm 3 > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

1
Q

Arteriodilators
- types of drugs

A
  • Calcium channel blockers (CCB)
  • Amlodipine
  • Hydralazine
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2
Q

Mixed Vasodilators
- types of drugs

A
  • ACEi’s > Benazapril
  • Angiotensin Receptor Blockers > Telmisartan, Nitroprusside, Sildenafil
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3
Q

Calcium channel blockers (CCB) - effects

A
  • Have several effects; vascular smooth muscle (VSM) vs myocytes
    > arteriodilator
    > negative inotrope
    > antiarrhythmic
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4
Q

Amlodipine
- what is it, what does it do?
- uses

A
  • CCB preferentially in VSM…….primarily an arteriodilator
    > Reduces afterload
    > increase SV and decrease in MVO2
    <><><><>
  • Used in to treat severe mitral regurgitation in dogs with chronic valvular disease (CVD)
    <><><><>
  • Also used to treat hypertension
    > Primarily renal secondary hypertension in cats; also hyperthyroidism and diabetes mellitus
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5
Q

Amlodipine toxicity

A
  • Slight negative inotropic effects
  • Compared to hydralazine:
    > Less reflex tachycardia
    > Less clinically significant hypotension
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6
Q

Hydralazine
- effects, uses

A
  • Directly relaxes VSM……PGI2 mediated ???
    pharmaforte.com.sg
  • Used in severe regurgitation; mitral or aortic insufficiency, VSD
    > Reserved for heart failure refractory to other dilators eg. ACEi’s or when sodium nitroprusside is impractical
    <><><><>
  • Potent arteriodilator
    > Reflex tachycardia possible
    > Hypotension a concern in heart failure patients
    > Titrate dose to effect; reduces risk of tachycardia and hypotension
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7
Q

Benazapril
- type of drug
- uses

A

ACEi’s (angiotensin converting enzyme inhibitor’s)
<><>
- Benazapril is a prodrug; converted to the active metabolite benazaprilat by the liver
<><>
- Used in dogs and cats for heart failure
> Agents only licensed for use in dogs for heart failure (DCM or MR)
<><>
- Benazapril also licensed for use in cats for kidney disease with proteinuria; heart failure use in cats is extra-label

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8
Q

ACEi’s (eg. Benazapril)
- general use?
- mechanism
- effects
- adverse effects

A

ACEi’s used as first line therapy in heart failure
- Block conversion of ATI to ATII by ACE
- Weak balanced vasodilation
> decrease afterload and preload
<><>
Neuromodulatory effects are most important
> blunts R-A-A-S and SNS activity and their detrimental effects
<><>
ACEi’s can promote hypotension
> Renal hypoperfusion can promote azotemia
> Hypotension greatest when other agents
are used concurrently eg diuretics and other vasodilators

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9
Q

Telmisartan

A
  • Approved in cats for proteinuria associated with chronic renal insufficiency in cats
  • Blocks the AT-1 receptor that normally binds AT-II
    > Blocks peripheral vasoconstriction
    > Blocks release of adrenal catecholamines and aldosterone
    > Blocks cellular hypertrophy and hyperplasia; remodelling
    <><><><>
  • May be useful in CHF and hypertension in dogs and cats
    > Limited veterinary data
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10
Q

Nitroprusside
- use
- mechanism

A

Use is limited for short term CRI in fulminant heart failure
> Half-life is very short; minutes
<><><><>
Vasodilation is the result of NO release from nitroprusside once
inside the VSM cell
> Tolerance to nitroprusside does not occur

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11
Q

Nitroprusside
- toxocity, considerations

A
  • Hypotension is possible warranting titrating doses upwards to effect while monitoring blood pressure
    > Concurrent use of positive inotropes is helpful
  • Cyanogen and thiocyanate build up and toxicity possible with prolonged treatment and/or renal compromise
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12
Q

Sildenafil
- mechanism
- uses

A
  • Vasodilation (arteries and veins) is the result of inhibition of phosphodiesterase V enzymes that breakdown cGMP primarily in the pulmonary vasculature
    > cGMP increases NO mediated vasodilation
    <><><><>
  • Is used to treat pulmonary hypertension of varying causes in the dog and foals
    <><><><>
  • Available in tablets, oral powder and injectable
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13
Q

Sildenafil toxocity

A

q Hypotension is possible
q GI upset reported in humans as well as
cutaneous flushing in the inguinal area

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14
Q

Negative Inotropes/Chronotropes
- what they do?
- use?

A
  • These agents decrease inotropy, decrease chronotropy but increase lusitropy (improve myocyte rate of relaxation)
    <><>
  • This group of drugs is used primarily to treat conditions with ventricular hypertrophy
    > Hypertrophic cardiomyopathy
    > Aortic, subaortic or pulmonic stenosis
    <><>
  • Also used as antiarrhythmics
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15
Q

Negative Inotropes/Chronotropes
- drugs in this class

A
  • Calcium channel blockers
    > Diltiazem
    <><>
  • β-adrenergic blockers
    > Atenolol, Propranolol, carvedilol
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16
Q

Diltiazem
- use

A
  • Preferential myocyte CCB
  • Main use is feline HCM
    > Directly improves myocardial relaxation
    > Reduces contractility
    > May reduce heart rate
17
Q

Diltiazem overdose issues

A

Overdose: bradycardia, vasodilation > syncope and collapse

18
Q

β-adrenergic blockers
- how they work?
- concerns?
- drugs and what they do

A

Beta blockers indirectly enhance relaxation of myocytes by reducing heart rate
- Limited experience with these agents in veterinary CHF
- Concern with decompensated HF due to worsening of signs
<><><><>
- Atenolol; selective β-1 adrenergic blocker
- Propranolol; nonselective β-blocker is also used
<><>
- Carvedilol; nonselective β-blocker with some ⍺1 antagonism
> Lower HR and reduce TPR that can reduce cardiac workload
> Same concerns as beta blockers

19
Q

Spironolactone
- what is this and what does it do?

A
  • Aldosterone receptor antagonist-potassium sparing diuretic
  • Weak diuretic action
  • Aldosterone blockade may slow progression of heart failure
    > Myocardial fibrosis and remodeling
    > Vascular fibrosis
    > Limited studies in veterinary medicine
20
Q

Drugs Used in Feline Thromboembolism

A
  • Antithrombotics > aspirin, clopidogrel
  • Anticoagulants > Heparin, Enoxaparin, Warfarin, Rivaroxaban
21
Q
  • heparin and enoxaprin > what are they, what do they do?
A

Anticoagulants for feline thromboembolism
- Acute injectable anticoagulants preventing new thrombus formation by enhancing antithrombin III activity
> Heparin inactivates both thrombin (factor II) and factor Xa
> Enoxaparin inactivates factor Xa, but not thrombin

22
Q

Warfarin - what is it, what does it do?

A

Oral maintenance anticoagulant that antagonizes vitamin K actions on clotting factors II, VII, IX and X; used as chronic preventative therapy……….. Less use in veterinary medicine now

23
Q

Rivaroxaban - what is it, what does it do?

A

Anticoagulant
q Inactivates factor Xa directly
q Being used more in veterinary medicine
q Given orally
q Use primarily in dogs thus far

3. Clin Pharm 3 (12 decks)

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