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RUSVM Pharmacology > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

1
Q

What are the non selective a-agonists?

A

Epinephrine

Norepinephrine

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2
Q

What are the selective a1 agonists?

A

Dopamine (high dose)

Phenylephrine

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3
Q

What are non-selective a antagonists?

A

Phenoxybenzamine

Phentolamine

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4
Q

What are selective a1-antagonists?

A

Prazosin

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5
Q

What are direct and indirect acting sympathomimetics?

A

Vasopressin
Ephedrine
Pseudoephedrine
Phenylpropanolamine (PPA)

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6
Q

What drugs are ACE inhibitors?

A

Enalapril

Benazepril

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7
Q

What is the MOA of enalapril and benazepril?

A

ACE inhibitors

Inhibit angiotensin II synthesis and aldosterone

Increase bradykinin (ACE usually inactivates)

  • vasodilator
  • stimulate PG
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8
Q

What is the osent on ACE inhibitors?

A

Usually slow with peak effects seen 1-2wks after starting treatment

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9
Q

Where are enalapril and benazepril metabolized and excreted

A

Both metabolized in the liver

Enalapril -renal clearance

Benazepril - hepatic > renal clearance

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10
Q

What are the indications for ACE inhibitors ?

A

Congestive heart failure
Hypertension
Protein losing renal disease -> reduce intraglomerular hypertension

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11
Q

What are the precautions to using ACE inhibitors ?

A

GI signs

Hypotension

Risk of worsening azotemia (high nitrogen) due to decrease GFR

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12
Q

What drug is a phosphdiesterase inhibitor?

A

Sildenafil

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13
Q

What is the MOA of sildenafil?

A

Phosphodiesterase V inhibitor -> increased cGMP -> nitric oxide (NO) mediated vasodilation

Smooth muscle of pulmonary vasculature

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14
Q

What are the therapeutic indications of sildenafil?

A

Treatment of pulmonary hypertension
Eisenmenger’s syndrome
Erectile dysfunction in humans

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15
Q

What are precautions to using sildenafil?

A

Systemic hypotension
Caution in hypovolemic patients, left ventricular outflow tract
GI signs

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16
Q

When is sildenafil contraindicated ??

A

Concurrent use with nitrates

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17
Q

What are the direct acting vasodilator?

A

Nitroprusside
Nitroglycerine
Hydralazine

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18
Q

What is the MOA of mictroprusside and nitroglycerine?

A

Increased formation of NO -> activate guanylyl cyclase -> increase cGMP -> stimulation of GMP-dependent protein kinase -> arteriolar and venous vasodilation

Relax vascular smooth muscle

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19
Q

What is the MOA of hydralazine?

A

Increase local PGI2 concentration -> alter cellular calcium metabolism in smooth muscle

  • interferes with calcium movements
  • prevent initiation and maintenance of contractile state
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20
Q

What are the indications to using hydralazine?

A 
Hypertensive crisis
Afterload reduction (severe CHF)
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21
Q

What are precautions to using hydralazine?

A

Hypotension -> may be severe
Syndrome
Weakness, lethargy

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22
Q

When is hydralazine contraindicated??

A

Renal disease
Reduce renal blood flow -> activate RAAS -> worsen renal injury

Pre-treat with ACE-I or spironolactone to reduce risk

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23
Q

What is the MOA of Amlodipine?

A

Calcium channel blocker

Inhibit the influx of extracellular calcium across myocardial and smooth muscle cell membranes

  • > decrease contractions
  • > dilation of the coronary and systemic arteries
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24
Q

What are the clinical effects of amlodipine?

A 
Neg inotropic effect
Neg chronotropic effect 
Increase oxygen delivery to myocardial tissue 
Decrease afterload 
Coronary vasodilation
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25
Q

What effects does amlodipine have on the vasculature?

A

Decrease peripheral resistance

Decrease systemic BP

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26
Q

What is the drug of choice for first line treatment of hypertension in CATS :)

A

Amlodipine

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27
Q

What are precautions to using amlodipine?

A 
Hypotension
Bradycardia 
AV block 
GI signs 
Elevated liver enzymes
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28
Q

What drug is an angiotensin II antagonist?

A

Losartan

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29
Q

What is the MOA of losartan? What is its indication?

A

Angiotensin II receptor competitive antagonist

Antihypertensive (adjunct therapy)

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30
Q

What is the mechanism of action of sildenafil?

A

PDE V inhibitor

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31
Q

What is the main indication of sildenafil?

A

Treat pulmonary hypertension

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32
Q

What drugs are used to treat pulmonary hypertension?

A

Sildenafil (drug of choice)

Pimobendan (can delay the onset, but not the treatment of choice)

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33
Q

What is the main clinical indication of amlodipine?

A

Treats systemic hypertension

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34
Q

What is a more balanced venodilator, hydralazine or nitroprusside??

A

Nitroprusside

35
Q

What is a hemostatic agent?

A

Helps support blood clotting

36
Q

What is an anticoagulant?

A

Inhibit coagulation factors

37
Q

What is an antithrobotic?

A

Inhibits platelets

38
Q

What is a thrombolytic?

A

Break down an existing clot

39
Q

What is the MOA of phytonadione

A

Vitamin K1

Necessary for the synthesis of coagulation factors II, VII, IX, X

40
Q

What are the vitamin K-dependent coagulation factors??

A

II, VII, IX, X

41
Q

What is the drug of choice for treatment of bleeding disorders associated with vitamin K1 deficiency

A

Phytonadione

42
Q

What is the antidote for anticoagulant rodenticide toxicity or hemorrhage associated with warfarin ?

A

Phytonadione

43
Q

How do you administer phytonadione?

A

ONLY give SQ -> risk of anaphylaxis if given IV

44
Q

What are the hemostatic agents ?

A

Phytonadione - vit K1
Protamine sulfate
Aminocaproic acid (antifibrinolytic)
Desmopressin acetate (hormonal agent)

45
Q

What is the MOA of protamine sulfate?

A

Complexes with heparin to form and inactive stable salt

46
Q

What is the drug of choice for treatment of hemorrhage secondary to heparin over dosage?

A

Protamine sulfate

47
Q

What are precautions to using protamine sulfate ?

A

Rapid IV injection

Hypotension 
Bradycardia 
Pulmonary hypertension 
Dyspnea 
Possible hypersensitivity reaction
48
Q

What is the MOA of aminocaproic acid?

A

Inhibits fibrinolysis via inhibitory effects on plasminogen activation substances and some antiplasmin action

(Inhibit clot breakdown)

49
Q

What is used to treat conditions associated with increased bleeding due to hyperfibrinolysis?

A

Aminocaproic acid (antifibrinolytic)

50
Q

Aminocaproic acid has been used prophylactiaclly to prevent post-op bleeding in _____________

A

Greyhounds

51
Q

What is the MOA of desmopressin acetate?

A

Causes dose-dependent in plasma factor VIII and plasminogen factor

Support primary hemostatis -> platelet function

52
Q

What is the drug of choice for treatment of bleeding due to vonWillebrand’s disease

A

Desmopressin

Also for central Diabetes insipidus

53
Q

What drug has been used to treat blooding due to aspirin toxicity in dogs

A

Desmopressin

54
Q

What is a precaution to desmopressin use?

A

Fluid and sodium retention with overdose

55
Q

What are the anticoagulants ?

A

Unfractionated heparin

Low molecular weight heparin (dalteparin and enoxaparin)

Warfarin sodium f

56
Q

What is the MOA of unfractionated heparin?

A

Binds to antithrombin III to inactivate coagulation factor Xa and prevents the conversion of prothrombin to thrombin

57
Q

What are the indications to use unfractionated heparin?

A

Heparinized saline flush
Treat certain thromboembolic disease
Prophylactic treatment in patients at risk of developing thromboembolic disease

DIC (controversial)

58
Q

What are precautions to using unfractionated heparin ?

A

Risk of bleeding
Heparin-induced thrombocytopenia

MONITORING -> coagulation time

Administered IV or SQ

59
Q

What are the low molecular weigh heparin ?

A

Dalteparin

Enoxaparin

60
Q

What is the MOA of low molecular weight heparin?

A

Bind antithrombin III to inactivate coagulation factor Xa

Preferentially inhibit factor Xa and have minimal impact on thrombin and clotting time

61
Q

What are the therapeutic indications to low molecular weight heparin?

A

Prophylactic to treatment of pulmonary embolism or thromboembolic disease

Deep vein thrombosis

62
Q

What are precautions of low molecular weight heparin

A

Hemorrhage unlikely, but possible

Must be given SQ
Frequent dosing
Expensive

63
Q

What is the MOA of warfarin sodium?

A

Inhibit vitamin K epoxied reductase

-> interfere with synthesis of coagulation factors II, VII, IX, and X

64
Q

What are the therapeutic indications of warfarin

A

Primarily used in dogs for the oral, long-term treatment of thromboembolic disease

65
Q

What are the precautions of warfarin?

A

Life threatening hemorrhage possible -> dose related

CAREFUL monitoring of clotting times

Highly protein bound -> drug drug interactions significant

66
Q

What are the antithrombotics?

A

Aspirin (NSAID)

Clopidogrel bisulfate (platelet aggregation inhibitor)

67
Q

What is the MOA of Asprin

A

Reduce platelet aggregation through inhibiting synthesis of thromboxane A2

Selective COX1 inhibition. -> anti-inflammatory

68
Q

What is the therapeutic indication of asprin ?

A

Prophylaxis or treatment of thrombotic disease

  • feline aortic thromboembolism
  • immune mediated hemolytic anemia
69
Q

Asprin is contraindicated in what cases

A

GI ulceration and active GI bleeding

70
Q

What are precautions of asprin use?

A

VERY long half life in cat -> EOD dose (72hrs)

High dose can cause increased platelet aggregation

71
Q

Clopidogrel bisulfate MOA?

A

Reduce platelet aggregation through selectively inhibiting the ADP receptor on the platelet surface

72
Q

What is the therapeutic indications of clopidogrel bisulfate

A

Prophylaxis or treatment of thrombotic disease

73
Q

When is clopidogrel bilsulfate used contraindicated?

A

GI ulceration and active GI bleeding

74
Q

What is a precaution to using patent aggregation inhibitor ?

A

AKA clopidogrel

Low risk of clinically significant bleeding when used alone

75
Q

What are the thrombolytic drugs?

A

Streptokinase
Urokinase
Tissue plasminogen activator (t-PA)

76
Q

What thrombolytic drug is fibrin clot specific?

A

Tissue plasminogen activator

77
Q

What is the MOA of thrombolytic?

A

Activate plasminogen to breakdown existing clots-> thrombolysis

78
Q

What is the therapeutic indication to using thrombolytic?

A

Treatment of existing thrombus or thromboembolism

79
Q

What are precautions to thrombolytic use?

A

Life threatening hemorrhage possible

Must be given IV

80
Q 
Which of the following dugs acts by inhibiting fibrinolysis ?
Vitamin K1
Protamine sulfate 
Aminocaproic acid 
Clopidogrel
A

Aminocaproic acid

81
Q

What is the specific antidote for anticoagulate rodenticide toxicity?

A

Vitamin K1

AKA phytonadione

82
Q

What is the MOA of clopidogrel?

A

Anti-platelet aggregation through ADP inhibition

83
Q

What is a fibrin clot specific thrombolytic?

A

Tissue plasminogen activator

RUSVM Pharmacology (18 decks)

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