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RUSVM Pharmacology Spring 2017 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the various cardiac stimulant classes?

A

beta 1 agonists, phosphodiesterase inhibtors, glucagon, and calcium salts.

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2
Q

What beta 1 agonist can be used to increase renal perfusion and GFR, at a low dose?

A

dopamine.

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3
Q

What are the effects of dopamine at a high dose?

A

vasoconstriction.

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4
Q

What is the drug of choice to treat sinus bradycardia, or incomplete AV block?

A

atropine.

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5
Q

What is the most likely cause of atropine not working when treating an incomplete AV block? What drug would you use instead?

A

It is a complete AV block if atropine doesn’t work. Use epinephrine instead.

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6
Q

Why is epinephrine contraindicated in incomplete AV blocks?

A

because it can cause tachycardia and lead to death.

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7
Q

If a patient has low BP, what would be the course of action? What two drugs would you avoid and why?

A

for low bp: give fluids and a vasoconstrictor, epi being drug of choice. Avoid phenylephrine or norepi b/c of the risk of reflexive bradycardia.

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8
Q

What is the result of severe heart failure?

A

pulmonary edema due to Na+ retention and stimulation of aldosterone.

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9
Q

What are the 2 therapies involved in treating congestive heart failure?

A

non drug therapy (restricted salt intake and exercise) as well as drug therapy.

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10
Q

What are the two classes of positive inotropic drugs used in treatment of CHF?

A

digitalis glycosides and beta 1 agonists.

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11
Q

What is the most commonly used digitalis glycoside? Is it still used today? Why or why not?

A

Digoxin. It isn’t used anymore because it’s not very safe. Has a narrow safety margin and can cause tachycardia/tachyarrhythmia

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12
Q

What drug has replaced digoxin?

A

pimobendin.

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13
Q

what are the 3 digitalis glycosides?

A

digitoxin, digoxin, and ouabain.

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14
Q

What is the MOA of digoxin?

A

inhibits Na+/K+ ATPase in the myocardial cell membrane, which increases the amount of Na+ available to exchange with Ca+. This causes an increase in intracellular calcium, thus increasing contractility.

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15
Q

What is the main cardiovascular effect of Digoxin? What is another effect of this drug on the heart?

A

positive inotropic effect. Increases the mechanical efficiency of the failing heart, without increased myocardial oxygen demand.

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16
Q

What is the goal when using digoxin?

A

normalization of blood pressure and peripheral resistance.

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17
Q

T/F: digoxin is good at treating edema due to CHF due to its diuretic effect.

A

True. This effect is secondary to increased cardiac output.

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18
Q

T/F: digoxin can be administered IV in case of ER.

A

True, but has to be administered slowly.

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19
Q

How is digoxin excreted in cats?

A

In cats, excretion is renal and hepatic. It is excreted in the bile.

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20
Q

What type of arrhythmias is digoxin used to treat? In what species?

A

supraventricular arrhythmias only in dogs.

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21
Q

What medication is used to treat digoxin toxicity?

A

cholestyramine

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22
Q

What beta 1 agonists are used to treat heart failure and when are they used?

A

dopamine and dobutamine. They are only used once by injection in severe cases.

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23
Q

What drugs are inodilators?

A

pimobendan, inamrinone, and milrinone

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24
Q

Why is pimobendan recommended over digoxin?

A

Wider safety margin and less likely to cause tachycardia.

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25
Q

When would you use inamrinone and milrinone?

A

as adjunctive therapy in severe cases of heart failure.

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26
Q

Why is pimobendan considered a balanced vasodilator?

A

Because it dilates both arteries and veins.

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27
Q

What is the MOA of pimobendan?

A

it sensitizes the cardiac contractile apparatus to calcium by enhancing interaction between calcium and troponin C complex. It doesn’t primarily increase intracellular calcium.

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28
Q

When is pimobendan contraindicated?

A

in hypertrophic cardiomyopathy and where an increase of cardiac output is not physically possible.

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29
Q

T/F: inamrinon and milrinone can be used for long term use.

A

False. They are arrhythmogenic and can not be used long term.

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30
Q

What is the best vasodilator to treat CHF?

A

ace inhibitors, because you get RAS stimulation. Beta blockers are good too because you get sympathetic stimulation.

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31
Q

Is prazosin used as a vasodilator for CHF?

A

no.

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32
Q

What diuretics are used in CHF?

A

loop diuretics, thiazide diuretics, and potassium sparing diuretics.

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33
Q

In what cases are beta blockers used in CHF and what do they do?

A

They are only used in mild or moderate cases of CHF. They blunt the adverse cardiovascular effects of the sympathetic.

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34
Q

What is the mode of action of carvedilol?

A

It is a non-selective beta-blocker and alpha 1 blocker. It inhibits endothelin release.

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35
Q

T/F: beta-blockers can increase serum potassium?

A

True.

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36
Q

What other drugs can be used in patients dying from heart failure?

A

oxygen therapy, morphine sulfate, aminophylline, and nebulization of ethanol (20%)

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37
Q

What type of arrhythmia leads to death? Why?

A

ventricular arrhythmia. Because they trigger ventricular fibrillation.

38
Q

Can hypoxemia cause arrythmias?

A

yes.

39
Q

What effect do class I B drugs have on action potential?

A

they shorten the duration of action potential.

40
Q

Which class I Sodium channel blocker has no effect on action potential?

A

Class I C

41
Q

T/F: Class I A drugs lengthen the action potential.

A

True.

42
Q

What class I A drug is the drug of choice to treat atrial fibrilation in equines and ventricular arrhythmias?

A

quinidine

43
Q

What drug is the drug of choice to treat ventricular tachycardia and tachyarrhythmia in dogs?

A

lidocaine IV.

44
Q

In what animal are class IB drugs more commonly used?

A

In cats, with the exception of lidocaine.

45
Q

What drug treats arrhythmias caused by digitalis?

A

Phenytoin.

46
Q

What are class IC drugs used for?

A

They are used by cardiologists to treat refractory tachycardia. They are very arrhythmogenic.

47
Q

Class II drugs are also known as ____.

A

Beta blockers.

48
Q

Which class II drug is the prototype for non selective blockers?

A

propranolol

49
Q

Which class II drug is the prototype for beta-1 selective blocker?

A

atenolol

50
Q

Class II drugs treat what type of arrhythmias and are used in what animal?

A

treat supraventricular and ventricular tachyarrhythmias. They are used in cats.

51
Q

Which drug is a non selective beta blocker that acts as a class III drug on the heart?

A

sotalol

52
Q

T/F: verapamil and diltiazem act against both ventricular and supraventricular arrhythmias.

A

False. They only act against supraventricular.

53
Q

What are the only 2 calcium channel blockers with anti-arrhythmic effects?

A

verapamil and diltiazem

54
Q

Which are better, calcium channel blockers or beta blockers?

A

calcium channel blockers.

55
Q

T/F: calcium channel blockers are contraindicated in CHF.

A

True.

56
Q

Wha is the drug of choice for supraventricular and ventricular tachyarrhythmias is cats?

A

beta blockers

57
Q

What antiarrhythmic drugs are used for bradyarrhythmias?

A

atropine, isoproterenol, and epinephrine.

58
Q

What drugs are used to treat second-degree AV blocks?

A

atropine, isoproterenol, and glucagon.

59
Q

Which drugs that act on blood vessels are used as decongestants? What problems can arise from these?

A

vasoconstrictors. They lose effect (tachyphylaxis) when used for a long time.

60
Q

What else are vasoconstrictors used for?

A

vasodilatory hypotension.

61
Q

epineprhine and norepinephrine are (selective/nonselective) alpha (agonists/antagonists)

A

nonselective, agonists

62
Q

phenylephrine is a (selective/nonselective) alpha 1 (agonist/antagonist)

A

selective, agonist

63
Q

How do beta blockers cause vasodilation?

A

indirectly by inhibiting renin.

64
Q

Phenoxybenzamine is a sympatholytic vasodilator that is the drug of choice to treat what?

A

hypertension due to pheochromocytoma.

65
Q

Which sympatholytic vasodilators are used in emergency hypertension?

A

non-selective alpha blockers.

66
Q

Why can angiotensin converting enzyme inhibitors (ACE inhibitors) be used to treat early-severe heart failure?

A

Because they don’t have a negative inotropic effect.

67
Q

Which ACE inhibitor is the only one approved in animals in the US?

A

enalapril

68
Q

Which ACE inhibitor is the only one approved in animals in CAN?

A

Benazepril

69
Q

T/F: ACE inhibitors can be given IV in case of emergencies.

A

False. Only given orally.

70
Q

What does renin cleave to make angiotensin I? What inhibits renin?

A

angiotensinogen, blocked by beta blockers

71
Q

ACE is also known as what? What 2 things does it break down and what are the end results?

A

ACE is also known as kininase. It breaks down angiotensin I, resulting in angiontensin II, and it breaks down bradykinin, inactivating it.

72
Q

What is the MOA of ace inhibitors?

A

inhibit angiotensin converting enzyme, thus inhibiting the synthesis of angiotensin II.

73
Q

Why do you worry about the kidneys when you lower blood pressure?

A

because of decreased GFR.

74
Q

What is the drug of choice to treat hypertension in dogs?

A

ACE inhibitors

75
Q

T/F: ACE inhibitors increase blood perfusion to the kidneys.

A

True. They only decrease GFR.

76
Q

Which is the most effective ACE inhibitor?

A

benazepril. 50% excreted in bile, 50% in urine.

77
Q

T/F: enalapril can be administered orally and parenterally

A

true.

78
Q

What are 2 direct-acting vasodilators?

A

hydralazine and nitrates

79
Q

What is hydralazines MOA?

A

increases local concentrations of PGI2 (vasodilator). It also may inhibit calcium influx into smooth muscles of arteries.

80
Q

What is the MOA of nitrates?

A

formation of the reactive radical NO, which activates guanylyl cyclase, increases cyclic GMP and stimulates GMP-dependent protein kinase

81
Q

direct acting vasodilators usually act on the receptors found where?

A

blood vessels.

82
Q

What are the drugs that fall under the class calcium channel blockers?

A

verapamil, diltiazem, amlodipine, and nifedipine.

83
Q

What happens if you block calcium channels in the heart?

A

you get an antiarrhytmic effect. Only a supraventricular effect (except for amlodipine or nifedipine)

84
Q

T/F: all calcium channel blockers are vasodilators and anti-hypertension

A

True.

85
Q

What is the drug of choice for hypertension in cats?

A

amlodipine.

86
Q

aside from calcium channel blockers, what other class of drugs decrease afterload and pre-load?

A

ACE inhibitors.

87
Q

What drug do you use on a hyperthyroid and hypertensive cat?

A

beta blocker.

88
Q

What is the drug of choice for myocardial hypertrophy in cats?

A

diltiazem.

89
Q

What are some adverse effects of CCBs?

A

bradycardia and AV block, hypotension, GI effects, and elevated liver enzymes (temporary).

90
Q

What are some anti-hypertensive drugs?

A

diuretics, beta blockers, vasodilators, and calcium channel blockers.

RUSVM Pharmacology Spring 2017 (10 decks)

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